I LIBRARY OF COI^GHESS. 1 

p) 

I €l]ap.l\^ 7 6^? 1 

I No. .H 1 5 





g UNITED STATES OF AMERICA. 



REMARKS 

ON THK 

UNITY OF THE BODY, 

AS II LUSTRATF.D BY 

SOME OF THE MORE STRIKING PHENOMENA 

OF 

SYMPATHY, 

BOTH MENTAL AND CORPOREAL, 

WITH A VIEW OF ENLARGING THE GROINDS AND IMPROVING THE 
APPLICATION OF THE 

CONSTITUTIONAL 

TREATMENT OF 

LOCAL DISEASES. 



MY 

GEORGE "kACILWAIN, 

AHOMnKR OF THE ROYAL COLLEGE OF SURGEONS; FELLOW OF THE ROYAL 
MED. AND CHIR. SOC. ; SURGEON TO THE FINSBURY DISPENSARY; 
CONSULTING SURGEON TO THE ST. ANn's SOCIETY; AND 
LATE SURGEON TO THE CITY OF LONDON TRUSS 
SOCIETY.' 



" However these things are in our depraved judgments and affections, yet 
Tiuth, which can alone judge itself, teaches, that the search, or courting the 
acquaintance and possession thereof, is the sovereign good of human nature " 

Bacon. 

LONDON: 
PUBLISHED BY S. HIGHLEY, 

FLEET STREET. 



1836. 



PREFACE. 



Although the science of Surgery may 
now be said to be founded on that " con- 
nexion of all parts with each other," which 
appears to have been a subject of such in- 
teresting contemplation to John Hunter, 
still it is to Mr. Abernethy that we are in- 
debted for that practical application of it, 
which he so properly termed " The Consti- 
tutional Treatment of Local Diseases." Mr. 
Abernethy may truly be said to have revo- 
lutionized the science of Surgery ; since a 
practice which was formerly confined to, 
or at least was chiefly characterized by, 
ministering to a part, now commences (al- 
though it by no means excludes local reme- 
dies), and often successfully concludes, by 
measures directed to the correction of the 
disordered state of the constitution. So 
far Mr. Abernethy's principles are in useful 



iv 



PREFACE. 



operation ; but whether the state of the 
constitution be enquired into with the re- 
quisite industry, or ministered to with 
that scrutinizing attention to the various 
functions, on which the successful apphca- 
tion of these principles so much depends, 
may justly be questioned. Still more doubt- 
ful is it whether the exhibition of remedies 
be conducted with those logical cautions, 
on which we must rely for any approach to 
accuracy in our deductions, — important in 
all investigations, and in none more than 
those which relate to sciences so far from 
exact as Medicine or Surgery. It is not, 
perhaps, proper or expedient, in this place, 
to enquire into the causes whence the cir- 
cumstances to which I have just alluded may 
have arisen. It is more to the purpose to 
assist in effecting their removal : and how- 
ever humble any iota of contribution to 
this object may be, we should not reject it, 
if it appear well intentioned. 

The constitutional treatment of local 
diseases is so beautifully illustrated, and so 
convincingly enforced, by considerations 
which refer to the chylopoietic viscera, that 



PREFACE. 



V 



it may perhaps have been allowed to rest too 
exclusively on such considerations ; and 
thus, under the influence of prejudice, or 
misconception, may have frequently encoun- 
tered scepticism, where, had the argument 
been more enlarged, it would have carried 
conviction. Now, nothing appears more 
emphatically to demonstrate that Unity of 
the Body, on which Mr. Abernethy's prin- 
ciples are essentially based, than the con- 
sideration of the phenomena of Sympathy ; 
and to arrange some of the more important 
of these in a form which, if it do not chal- 
lenge correctness, shall at least not disgust 
by its difficulty, has been my first object. 
In order to impress that linking together of 
individual existences, constituting the con- 
nexion of the whole with all its parts, I have 
endeavoured to shew that the mind fur- 
nishes its quota of illustration. I have also 
endeavoured to exemplify the bearings which 
the sympathies especially, have on the ex- 
planation of diseases; and in, not only esta- 
blishing the excellence, but also in improv- 
ing and enlarging the application of the 
constitutional treatment of them. In con- 



vi 



PREFACE. 



ducting the illustrations, there is no one 
sympathy of which twenty more manifesta- 
tions might not have been mentioned ; but 
this, though very necessary in a work with 
no other object than a systematic account 
of the sympathies of the body, would be 
inconsistent with the design of this volume ; 
whilst, for the purposes of the argument, 
one fact, with regard to an individual sym- 
pathy, if it be indisputable, is as good as 
twenty. It may have happened, that I 
have not always made the most happy se- 
lection in the example of a given sympathy ; 
but I know not how this objection could 
have been certainly avoided ; because what 
appears very trite and demonstrative to one 
man, may not be so to another. 

With the tabular view, which I have 
annexed at the end of the volume, will be 
(bund its requisite apology. 

Last year, in an endeavour to correct 
some misconceptions which prevail with 
regard to the opinions of Mr. Abernethy, 
I added such arguments as a general view 
of the influence of the digestive organs 
seemed to furnish, to awaken a more lively 



PREFACE. 



vii 



and strict attention to the principles which 
it was my object to advocate. This dis- 
course conchides the present vohime. 

I may observe, that the " Remarks," &c. 
constituted some mtroductory lectures, and 
that they have been allowed to retain nearly 
their original form, with the exceptions of 
such breaks, or divisions, as seemed calcu- 
lated to aid their perspicuity. 



Argyll Place ^ 
Dec. 1835. 



INDEX. 



CHAP. I. 

PAGE 

Introduction of the subject I 

Analytical examination recommended 10 

CHAP. II. 

Manifestations of sympathy irregular 13 

Common or general sympathy , 16 

Of structural sympathy 18 

mucous membranes 19 

fibrous structures 20 

bone 23 

muscles 24 

serous membranes 27 

cellular tissue 28 

absorbent glands 30 

salivary glands 32 

Of sympathy of mechanical relation 35 

vensB portee, hoemorrhoids, heart, uterus, rectum, and 

bladder 39 

Of functional sympathy ^ 40 

alimentary canal with its different portions 42 

• and skin 43 

skin and lungs 44 

and kidney 45 

and heart 46 

of the skin with its several parts 49 

heart and kidney 52 

and lungs „ 53 

b 



X 



INDEX. 



liver and bowels 55 

stomach and liver 56 

nrethra and urinary organs 58 

uterus and mammary glands 01 

CHAP. IV. 

OF INTERMEDIATE SYMPATHIES. 

Stomach and lungs 65 

Liver and lungs « 69 

Stomach and kidney , 72 

— and heart 74 

and testicle . » 75 

and uterus. 77 

Uterus and kidney 80 

Anomalous sympathies 80 

Of the countenance 85 

CHAP. V. 

Of the brain 90 

Of the sympathy of the external senses with the body . . 92 

of the external senses with each other. 94 

external senses with the mind 99 

Of the sympathy of the mind and body 103 

Of reason and the passions 105 

Of their sympathies with corporeal organs 105 

CHAP. VI. 

Sympathy considered in its application to disease 118 

Chiefly interesting to the surgeon 119 

Consideration of sympathy establishes many facts .120 

, assists us in understanding the 

causation of disease 121 

This remark considered 123 



INDEX. 



xi 



The phenomena of catchmg cold considered .129 

Explanation of them attempted 139 

Circumstances influencing cutaneous susceptibility, or 
predisposing causes ; and why the digestive or- 
gans so extensively 139 

Of sympathetic effects through organs primarily affected. loO 

secondarily affected. 152 

Of vapour bathing 154 

Of local remedies as explicable by sympathy 156 

Application of sympathy to treatment continued 165 

Cases in illustration 1(>8 

Application of sjanpathy in avoiding such frequent re- 
course to remedies which, notwithstanding the be- 
nefit which attends them, prove often ultimately 

pernicious 185 

Of the abuse of mercury — as producing diseases simulat- 
ing syphilis, when the mercury has been given for 

other affections — cases 19^ 

Unnecessary employment of powerful means not confined 

to mercury 215 

Of diseases of joints 222 

Author not to be understood as recommending a practice 

which merely ministers to symptoms 229 

Discourse pursuing the argument as regards the diges- 
tive organs 237 

Retrospective view of surgery 238 

Sketch of Hunter and Abemetliy 239 

Mr. Abernethy's views of life considered 248 

misrepresentations of 250 

Mr. Abernethy's views of disease 254 

His views contended for and testified by diseases of all 

periods of life 200 

By a brief review of the anatomico-physiological relations 

of the chylopoietic viscera 265 



xii 



INDEX. 



Digestive organs not to be too exclusively considered, not- 



withstanding, in the treatment of diseases ...... .265 

Exhortation to avoid the errors of even the greatest men. .274 

Hospital and dispensary practice 280 

Conclusion 281 

Tabular view of sympathies 289 

Postscript 294 



ERRATA. 



Page 5, for final, read secondary. 

32, — accompaning, read accompanyino:. 

43, — similar disorders, read dissimilar disorder'^. 

— 62, ~ little bud, read little bird. 

153j — that the extreme, read the extreme. 

tertially, read tertiarily. 

189, — by any easy, read by an easy. 

— — 191 , — 'nore prevalent, read most prevalent. 
19 1, — i forms ol'diseases, read forms of disease. 



CHAPTER 1. 



Whether we study accidents, or dis- 
eases, or reflect on the means by which 
they are reheved, nothing appears more 
important, nothing more essential to Sci- 
entific Surgery, than a conviction of the 
perfect Unity of the Body — by which I 
mean, an enlarged view of the animal oeco- 
nomy, which, whilst it recognizes a mul- 
tiplicity of organs, presenting a varied 
arrangement of comparatively few elements ; 
— -which, whilst it embraces a number of 
facts, infinitely modified in their relations 
to the whole body, and to each other, shall 
yet contemplate them as parts of a grand 
whole, as constituting one integral fabric, 
and combining in one object ; the life of the 
individual. This view of the subject lends 
the greatest interest to the progressing ac- 
cumulations of experience and observation ; 

B 



2 



it explains the uses of facts so accumulated, 
in a manner most easy and most consonant 
with reason ; and most readily confers on 
us the power of applying them with promp- 
titude, either to the preservation of health, 
to the correction of disease, or to its sus- 
pension, or amelioration, where correction 
is beyond our power. 

To the surgeon, the labours of John 
Hunter owe their chief value to the force 
with which they inculcate this principle of 
study ; nor can the investigations of Mr. 
Abernethy, nor the hght which his genius 
threw on those of Mr. Hunter, be remem- 
bered with a more just gratitude, than when 
viewed as contributing so largely as they 
unquestionably did, to establish such views 
of the animal oeconomy. On a former 
occasion, I endeavoured, in correcting some 
misapprehensions which exist with regard 
to the opinions of Mr. Abernethy, to en- 
force this connexion of all the parts of the 
body with each other, by such illustrations 
as were afforded by a cursory considera- 
tion of the Digestive Organs* ; and also to 

* See the concluding discourse of the volume. 



3 



explain how the opinions of Mr. Hunter 
and Mr. Abernethy, though commencing 
at different points, and taking different 
courses, ultimately met in an identity of 
conclusion. 

In furtherance of this object, I mean 
the connexion of all parts with each other ; 
I wish now to direct your attention to those 
phenomena which, though inscrutable in 
their nature^ are very apparent in their 
operation ; which, like sentinels to the 
animal oeconomy, guard its portals from 
noxious influences, communicate alarm 
when they shall have gained admittance, 
or excite exertions for their expulsion. 
I wish to consider those laws which con- 
tribute so largely to our happiness, or 
misery, according as they operate in the 
harmony of health, or in that unbalancing 
of the functions which characterizes dis- 
ease. It is to those mysterious links, in 
the chain of vital phenomena, Vv^hich con- 
stitute the sympathies of the body, that I 
claim your attention. It appears to me 
that their importance in the treatment of 



4 



diseases is by no means duly appreciated ; 
that a more frequent and easy recurrence 
to the wide range of facts which they com- 
prise is absolutely necessary ; and that the 
first step to this must be a closer and a 
more analytical examination than we have 
been accustomed to afford them. 

If medico-philosophical enquiry present 
no subject more hnportant or interesting ; 
none having more direct bearings on the 
treatment of disease ; it is equally true that 
it furnishes none more difficult. 

Its difficulties render enquiry laborious 
and ungrateful ; its doubts, with nothing 
decided but their infinity, repress the desire 
for investigation. Were we discouraged, 
however, by difficulty, knowledge would 
no longer be progressive, and we should be 
deprived of many unfading sources of en- 
joyment, not only the highest as being most 
intellectual, but the best as being most 
pure. 

Let us rather strive to make the diffi- 
culties themselves our coadjutors ; let them 
teach us that circumspection in enquiry 



5 



which examines every part of a subject, 
without being aUured by the more pro- 
minent or seductive points of it. Let them 
induce a ceaseless caution in our conclu- 
sions. Let them, in impressing on us the 
finite nature of our faculties, induce an 
humbleness of mind, which, if it does not 
always conduct us to the sanctuary of truth, 
at least teaches us to avoid the fastnesses 
of prejudice ; diffuses a calmness and sere- 
nity through the mind most favourable to 
mental exertion ; and preserves us from 
disappointment, when we find how limited 
those results prove, which are alone within 
the reach of our measured perceptions. 

Though the final causes of things be 
concealed from us, as probably neither 
adapted to our present capacity nor our 
happiness ; yet, so far as the progress of 
knowledge has hitherto enabled us to judge, 
it would appear, that those facts, which are 
really useful to us, lie well open to inves- 
tigation, and are easily appreciable by the 
human understanding. It would also seem, 
that there is scarcely any part of our know- 
ledge, however recondite, of which some 



6 



type — shall I say suggestion ? — has not 
been presented on the very surface of na- 
ture. We know not the nature of light, 
still less of the instrument by which the 
Creator puts it in such rapid motion ; but 
a thousand phenomena, of daily occurrence, 
illustrate its laws ; nay, even its composite 
nature, a comparatively recent discovery, 
has always been exemplified in a pheno- 
menon no less striking than the rainbow. 
How strange it seems to us, when we con- 
sider such matters for the first time, that 
the principal agents in nature should be 
invisible ! as electricity, galvanism ; or that 
so much of matter, should be resolvable into 
invisible gases ; yet we find a type of this 
in the very air we breathe ; the substantial 
nature of which, if not suggested by re- 
spiration, is pleasingly disclosed to us in 
the fanning of the breeze, or strikingly de- 
monstrated in the sweeping of the tempest. 

It appears to have required the mind of 
a Newton, to have proved, by mathematical, 
the most approved method of human ratio- 
cination, that the hexagonal form of the 
bee-cell was actually the best possible for 



7 



(^economy of space*. Every bee-hive, how- 
ever, shewed its beautiful and successful 
adaptation to the adjustment of thousands 
in a very small space ; who, next to their 
number and industry, were so distinguished 
for the order of an apparently crowded 
community, as to have furnished its most 
interesting example to man in all ages ; 
an illustration as simple and remarkable, as 
the proof of the principle of the rule might 
be difficult ; and which would suggest to the 
natural theologian the same conclusion 
which Newton's calculus would demon- 
strate to the mathematician. 

Numerous similar illustrations of the 
valuable parts of subjects, lying near the 
surface, might be adduced. Let us hope 
that this may ultimately prove the case 
with regard to the sympathies of the body. 
Mr. Hunter was strongly impressed with 

* How strikingly does this suggest that limited reliance 
on our own senses which I cannot but think is too often over- 
looked hy anatomical investigators, and that (as Mr. Aberneth j 
used to observe) many things, though not perceivable by our 
senses, are not the less demonstrable to reason. 



8 



their importance, and laboured hard, if not 
to explain their nature, at least to mark 
their operation. Mr. Abernethy, who heard 
Mr. Hunter's lectures, used to say, with the 
quick perception, or, if you please, with the 
characteristic impatience of genius, that 
Mr. Hunter, at last, only proved that the 
whole, sympathized with all its parts. This, 
no doubt, expressed the result and inten- 
tion of Mr. Hunter's endeavours ; but it 
may reasonably be said, that a more ana- 
lytical treatment of such a subject, espe- 
cially in the hands of Mr. Abernethy, 
would have much enlarged the utility of 
Mr. Hunter's discourses ; have impressed 
the facts much more strongly on the mind, 
and have more clearly unfolded the in- 
fluence of this sympathy, in the derange- 
ment of health, and in the treatment of 
disease. 

The analytical examination of the 
grounds on which a fact rests, not only 
tends to strengthen our belief in it, but is 
necessary, if we require conviction. It is 
a kind of intellectual chemistry, which, 
resolving a fact into its constituent prin- 



9 



ciples, discloses the extent, variety, and 
importance, of its application. It reveals 
to lis numerous phenomena, no more sug- 
gested by the ultimate fact which they tend 
to establish, than the homogeneous ap- 
pearance of many compounds, suggests 
their complicated elements. To know the 
strength of a chain, we must be convinced 
of its unity ; and this we only effect by 
examining the Hnks of which it is com- 
posed. 

Conviction, thus obtained, (to say 
nothing of the useful views frequently 
arising in its progress) is emphatically our 
own ; the mind, recognizing it as such, ap- 
plies it with promptitude, almost without 
an effort, to the purposes it may be de- 
signed to serve. Compared to faith, how- 
ever unreserved, on the dicta of another, 
it is the inductive result of the highest in- 
tellectual operation, contrasted with a blind 
confidence in authority, in which reason 
has commonly little or no share. No one 
can doubt that Mr. Hunter entertained 
such views : it is certain he treated the sub- 



10 



ject in the way they would recommend ; 
viz. by an examination in detail. 

It cannot, perhaps, be denied, that ana- 
tomy has fornished some assistance in en- 
quiring into the phenomena of Sympathy ; 
but it is to be feared that more has been 
expected from it than it is capable of sup- 
plying ; whilst, by engrossing too exclusive 
an attention, it may sometimes have closed 
more enlarged, and perhaps more promis- 
ing, avenues for investigation. In pointing 
out universal nervous communications, it 
suggests, a priori, the functional integrity 
of the body ; in shewing identical tissues, 
arranged in different situations, and, in as- 
sisting our physiological conclusions as to 
individual organs, it facilitates the classi- 
fication of phenomena ; applied to the 
explanation of individual sympathies, it 
affords us little help : if it occasionally 
hold out promise in this way, it is but to 
allure us to disappointment. 

The consideration of the eighth pair of 
nerves and itls communications with the 



branches of the cervical gangha of the 
sympathetic, and the sympathies of certain 
parts to which these are distributed; and 
the inadequacy of any apphcation, I may 
say the absence of analogous facts, when 
we consider other sympathies no less re- 
markable, the uterus and stomach, for ex- 
ample, — illustrate this remark. 

We do not indeed expect anatomy to 
assist us in explaining the most marked 
sympathy of all ; namely, that between mind 
and body ; but its failure here is but typi- 
cal of its incompetency to explain many 
corporeal phenomena. We shall probably 
obtain more advantage from a careful ob- 
servation and notation of the phenomena 
which are daily unfolded to us ; of the cir- 
cumstances by which they are preceded, 
accompanied, or followed ; and, when our 
facts shall have become multiplied, by ex- 
amining how far we can establish that co- 
existence or sequence of any of them, which 
shall suggest the idea of a law, in the mode 
of their production. At present, we can be 
said to know scarcely anything of the laws 
of sympathy. They exercise a momentous 



12 



influence, and generally of a salutary ten- 
dency. If they sometimes contribute to 
our decline, they but remind us that death, 
as well as life, is a law of our nature. 



13 



CHAPTER II. 



In contemplating the sympathies of the 
body, it is more easy to make a convenient 
arrangement than a scientific classification. 

Sympathetic actions are sometimes si- 
milar to the primary impressions ; some- 
times not*. Affections of the absorbent 
glands are sometimes similar to those whicli 
produce them ; sometimes, common irrita- 
tion. When o:onorrhoea affects the eve, 
the action induced is similar ; when it af- 
fects the testes, it is not so. 

Sympathy is sometimes reciprocal ; as 
in the head and stomach, stomach and 
bowels, or skin and kidney : at other times 
it appears to act chiefly in one direction ; 

* See J. Hunter ; Reminiscences, Art. Sympathy. 



14 



as when the testicle sympathizes with the 
urethra, or the stomach with the testicle. 
These are common occurrences. But it is 
seldom that we see the testicle sympathizing 
with the stomach, or the urethra with the 
testicle. 

Sometimes, sympathetic actions are 
more prominent than the primary impres- 
sions ; as when the head sympathizes with the 
stomach or liver ; or the knee in incipient 
diseases of the hip ; or the shoulder with 
the liver : at other times, less so ; as in many 
irregularities of function in the kidney, 
either in dyspepsia, or disordered bowels. 

Sometimes, they appear to have a refer- 
ence to the properties, whether functional 
or organic, of the parts between which they 
occur ; as in the heart and lungs ; or in mu- 
cous membranes : sometimes, they have no 
such reference ; as in the uterus and sto- 
mach, or testicle and parotid glands. 

Sometimes, they appear in relation to 
continuity of surface ; as in the skin, peri- 
tonaeum, or urethra ; or contiguity of posi- 
tion, as bladder and rectum ; or to other me- 
chanical relations ; as those of the vena portge 



15 



and hsemorrlioidal veins: sometimes, without 
any such relation, as in the sympathy of the 
stomach and kidney. On the other hand, 
these relations sometimes exist, without any 
manifestation of sympathy ; as in the con- 
tiguity of muscles and absorbent glands, or 
the mechanical relations of the thyroid gland 
and larynx. The larynx sympathizes very 
little with the thyroid gland, unless this be 
changed in structure. Bronchocele, which 
is merely an enlargement of the natural 
structure of the thyroid, seldom produces 
any affection of the larynx, unless it be 
from its weight and pressure. There is an 
example of the absence of any sympathy of 
the larynx in a patient now in the Dis- 
pensary. She is a young woman, aged 18, 
a native of Buckinghamshire. The bron- 
chocele measures, in its transverse diameter, 
13| inches ; its circumference measures two 
feet, less three quarters of an inch. 

The modes in which sympathetic actions 
are manifested are indefinitely modified, as 
regards the parts between which they are 
developed, in different persons ; or at differ- 
ent times in the same individual ; either as 



16 



the result of natural peculiarity, or that, con- 
sequent on disease. A large volume would 
scarcely afford space for a full discussion of 
this extensive subject : I need not say that 
it is impossible to accomplish it in the limits 
which various considerations have induced 
me to prescribe to these observations. 

It appears convenient, in the first place, 
to divide sympathy into common, and pro- 
per ; general or particular : and, having ex 
plained the former of these terms, to make 
such subdivisions of the latter, as shall ap- 
pear necessary. 

By common or general sympathy, I 
mean that sympathy of the whole with all 
its parts, demonstrated by the multiform 
and interesting phenomena, usually in- 
cluded in the term constitutional irritation. 
A sympathy, peculiar to no organ, but com- 
mon to every structure in the body ; seen 
alike in primary affections of the nervous, 
respiratory, and circulating systems ; the 
whole of the chylo-poietic viscera, the 
urinary and generative organs ; in glandular 
structures, whether absorbino; or secretino; 
organs ; in skin, muscle, bone, tendons, 



17 



ligament, cartilage, and in the cellular 
tissue, whether this be expanded into sheets 
of membrane, or employed in the more com- 
mon office, as a connecting medium ; a sym- 
pathy which, though more marked in some 
instances than others, as in the effects of 
teething, and in symptomatic fever, is 
nevertheless seen, in greater or less degree, 
in almost every malady presented to the 
physician or surgeon. The great example 
of that unity to which all the sympathies 
contribute, it is as it were the focal centre 
around which these sympathies revolve, 
and the point in which their converging 
influences meet for the preservation of the 
body ; a chain connecting all parts by the 
particular or individual sympathies, some 
of which we are next to examine. 

First, then, we will divide these, as they 
appear to be more or less influenced by the 
circumstances which the terms imply ; into 
the structural, functional, and intermediate : 
sympathies of mechanical relation ; sym- 
pathy of absorbent glands ; anomalous sym- 
pathies ; sympathies of idiosyncrasy. These 
divisions will probably be sufficient for our 

c 



18 



purpose. The illustrations will necessarily 
be brief, and, for obvious reasons, as trite 
as possible. 

STRUCTURAL DIVISION, 

Including parts presenting either identity 
or analogy of structure. 

The parts which seem most convenient- 
ly to range themselves in this division, are 
the mucous, serous, and fibrous membranes, 
fibrous structures generally, muscles, bones, 
the apparatus of joints, and cellular tissue. 

Mucous Membranes, 

The mucous membranes present the 
largest surface in the body, the skin only 
excepted, of which indeed they appear but 
a modified involution. Their sympathies 
are marked and important, and, in relation 
to the skin especially (as will hereafter be 
explained), exert a very extensive influence 
in the production of the diseases of this 
climate. 



19 



The sympathy of mucous membranes 
with each other is seen in the various affec- 
tions of the stomach, producing disorders 
of other portions of the ahmentary canal, 
or vice versa ; or in the same reciprocity 
of sympathy exemphfied in the mouth, 
nose, fauces, trachea, and bronchial ramifi- 
cations, and stomach ; in the sympathy of 
the urethra and bladder ; or in the conjunc- 
tiva of the eye with the urethra, in various 
cases of gonorrhoeal ophthalmia, and other 
minor affections of a similar kind, but not 
falling under that designation. Irritation 
of the alimentary canal from worms, or 
otherwise, will produce irritation in the 
nose ; or irritation applied to the nose, 
especially that resulting from snuff, will 
affect the alimentary canal. 

The sympathies of the mucous mem- 
branes with the skin are equally important. 
They are displayed in affections of the 
stomach, bowels, lungs, and urinary organs ; 
and are reciprocal, appearing in a manner 
equally marked, whether the impressions on 
these organs be primary ; or secondary, as 
from cold. The sympathy of the mucous 
c 2 



20 



membranes of the alimentary canal and 
skin is further seen in the whole of the dis- 
eases of the skin, which, for the most part, 
are but examples of such sympathy. 

Fibrous Structures^ 

Such as the dura mater, pericardium, 
periosteum, ligaments, tendon, &c. have 
marked sympathies with each other ; and 
frequently exemplify, in their readiness to 
sympathize with general disturbance, a 
remark of Mr. Abernethy's ; viz. that parts 
most disposed to suffer, under such circum- 
stances, were those either possessing " least 
life, or most susceptibility." The sym- 
pathy of these parts with each other, and 
with the skin, is best exemplified in many 
instances of a common cold, and in the 
phenomena of rheumatism ; with the skin, 
in the disorder frequently impressed through 
that organ, and frequently immediately sub- 
jacent to the part on which the cold has 
been applied ; with each other, in the fre- 
quent metastasis of most of their affections, 
(rheumatism more especially): from one joint 



21 



to another, or from a joint to some fibrous 
membrane, even that of the heart itself. 
In the fasciae, both in their proneness to 
sympathize with similar structures, as joints, 
as well as to be primarily affected by the 
same impressions, as cold. 

A case occurred, about four years ago, 
of a very severe inflammation of the 
fascia of the thigh, ultimately involving the 
femoral vein, which, from its general in- 
terest, I think worth relation. A poor boy, 
not very well clad, was sitting on a gate on 
a cold day, and he felt the wind blow on 
his thigh, which was quickly followed by a 
very acute pain in the same situation. He 
immediately went home, which he reached 
with difficulty ; and on the second day his 
parents applied at the Dispensary. On 
examining his thigh, it was neither red nor 
swollen, or very little, but extremely pain- 
ful, and exquisitely tender on the slightest 
pressure. I told the gentlemen who ac- 
companied me that I regarded it as inflam- 
mation of the fascia. His health was much 
disordered, and his pulse indicated excite- 
ment with want of power. Leeches were 



22 



freely applied to the part, with fomentations 
and poultices ; and he was seen again the 
next day. The limb was now swollen, but 
not discoloured, excessively painful, and ex- 
hibited an appearance which led me to re- 
mark, that had it been in a woman recently 
parturient, it would be called phlegmasia 
dolens. The treatment consisted of further 
local depletion and mercury ; but the ra- 
pidly increasing depression of the sys- 
tem, which had been observed from the 
first, obliged us to relinquish the plan, and 
endeavour to support him by such means 
as seem likely not to produce excitement. 
Notwithstanding the most sedulous atten- 
tion to the conflicting indications, he gra- 
dually sank. Examination discovered a 
very considerable thickening of the fascia 
of the thigh, and of the cellular tissue : a 
moderate quantity of pus lay around and 
in the course of the femoral vein, which, 
on being laid open, was found also to con- 
tain pus, with considerable depositions of 
coagulable lymph. 

Another case, in all respects similar, 
occurred about a year after the preceding ; 



23 



but, as indisposition prevented me from 
seeing the case more than twice, I am in- 
debted to Mr. Wright, an inteUigent pupil, 
who had the care of the case, for the follow- 
ing particulars : — He does not remember 
that the exact cause was ascertained : the 
treatment was the same as in the former 
case, at first ; and, subsequently thereto, was 
directed to the regulation of his diet, and 
the alvine secretions. This boy recovered. 

Rheumatism and colds also illustrate the 
sympathies which exist between the fibrous 
and mucous structures ; they are seen in the 
disordered secretions of the latter, which, 
from some surface or other, so constantly 
attend disordered affections of fibrous struc- 
tures originating in cold. Nothing, how- 
ever, more strikingly demonstrates the sym- 
pathy of mucous and fibrous structures, 
than the phenomena of stricture, and what 
has been called Gonorrhoeal Rheumatism. 



Bone, 

I mention bone in this place as ranging 
itself most conveniently with the structure 



24 



of joints. Its sympathy with itself is per- 
haps best illustrated in metastasis, where 
the affection of the bone has produced no 
organic derangement, and in the quick 
participation of the osseous system in im- 
pressions appKed to any part of it. The 
sympathy of bone with fibrous structures 
is exemphfied in its ready participation in 
impressions primarily addressed to those 
structures ; and in its own susceptibility of 
the primary influence of such impressions. 
The phenomena of rheumatism, and the 
abuse of mercury, illustrate this sympathy. 



Muscles. 

One of the most common examples of 
muscular sympathy is the spasm which 
sometimes accompanies Rheumatism ; and a 
fearful proof of this sympathy, as well as 
that which appears to exist between muscles 
and less highly organized fibrous structures, 
is seen in the occasional history, and always 
in the phenomena, of tetanus. Ordinarily, 
however, the muscles do not evince any 
very remarkable tendency to sympathize 



•25 



with each other, unless we regard that 
etiulibriiim, as an example of it, which is 
seen in the balance of their actions. 

Perhaps so large a portion of them 
being under the influence of the will (which 
never happens with regard to organs, whose 
constant action is necessary to life), may 
have some effect in rendering their ordinary 
sympathies less remarkable, as they would 
have been obviously, inconvenient. 

It may be observed, that in proportion 
as muscles become removed from the 
influence of volition, so do their sympathies 
become enlarged, or excitable. 

The sphincter muscles, over which the 
will has a very restricted control, sympathize 
very readily with each other, as is seen in 
many affections of the bladder and rectum. 

The diaphragm and abdominal muscles, 
which are neither under the dominion of 
the will, nor absolutely involuntary, have 
enlarged and very important sympathies; 
and in something like proportion to their 
subjection to volition. The abdominal 
muscles present scarcely any phenomena, 
over which the will has not some power 



26 



of modification ; the diaphragm presents 
several over which vohtion has scarcely any, 
I had almost said, no power ; as in hiccough, 
and some of the more violent effects of 
the passions. 

We accordingly find that the abdominal 
muscles present very interesting sympathetic 
phenomena; both with regard to the dia- 
phragm, and the viscera which they enve- 
lope and protect: yet that the sympathies 
of the diaphragm, are much more vivacious 
and extensive; and only surpassed by those 
of the heart itself, which, I need scarcely 
add, is altogether an involuntary muscle. 

Voluntary muscles, however, occasionally 
display great sympathy with the parts in 
contact with them ; as when they suffer from 
cold, as in the common stiff neck, as it is 
called ; or when their irritability is excited, 
as in the spasm of fracture ; or in the tenacity 
with which they maintain a dislocation. It 
is curious, however, to observe, that, under 
such circumstances, voluntary muscles ac- 
quire properties not natural to them; but 
which appertain to those which are involun- 
tary ; viz. that the power of volition becomes 



27 



much limited, or the muscles act inde- 
pendently of it ; and tliat they act also 
much longer without intermission, than 
they can do under ordinary circumstances. 

Serous Membranes, 

The sympathies of the serous mem- 
branes with each other, are perhaps not so 
frequent, nor so marked, as those of the 
mucous structures; neither are the serous 
membranes exposed so frequently to the 
agency of external impressions. They pre- 
sent phenomena, how^ever, unequivocally de- 
monstrative of their sympathetic connexion. 
The sympathy which a serous membrane 
exhibits with all its parts, is exemplified in 
the fact, that there is no surface in the body 
(if we except the skin) over which an action 
spreads with the same rapidity, or with such 
a preservation of its identity : a disposition 
of the greatest importance where the mem- 
brane is connected with important viscera ; 
rendering inflammations of them highly dan- 
gerous, both from the extent of surface which 
they so rapidly occupy, and the number and 



28 



importance of the functions which they 
embarrass or suspend. The serous mem- 
branes, as secreting surfaces, sympathize 
with generally loaded states of the vascular 
system, whether dependent on absolute re- 
pletion, or that which is consequent on the 
diminished power or impaired function of 
particular organs : as we see in inflam- 
matory dropsy, or effusions connected with 
diseases of the abdominal or thoracic vis- 
cera : Apparently composed of condensed 
cellular tissue; in other respects, they appear, 
like it, to derive their sympathies from the 
organs with which they are in mechanical 
relation. 

Cellular Tissue. 

Regarded abstractedly, there does not 
appear to be much peculiarity in the sym- 
pathy of the cellular system. Serving as a 
medium of communication, as well as a bond 
of connexion between different parts, its 
preservative actions seem chiefly concerned 
in modifying these relations. Its sympathy, 
in the ordinary sense of that term, seems 
to be in common with the part, to whose 



29 



structure it contributes, or in wliose vicinity 
it occurs. 

Pathologically considered; cellular tissue 
presents many phenomena, highly important 
and interesting ; and which appear referable 
to a sympathetic connexion with the parts 
with which it is in relation. 

These phenomena seem to consist of 
actions of a salutary kind, and may be re- 
ferred to one principle; viz. the limitation 
of disease. A connecting medium for all 
parts of the body, very various in its 
density ; it appears, nevertheless, seldom to 
lose either its cellular character, or its elas- 
ticity. These properties, whether separate, 
or in conjunction, appear to be favourable 
to the communication of vascular excite- 
ment, which in some variety or degree, seems 
to be the first step in disease. Wlierever 
disease occurs, the cellular tissue gene- 
rally takes on an action destructive of 
both its cellular and elastic property ; 
this is seen in the adhesive circumval- 
lation of abscess, and in the endless 
variety of thickening and condensation of 
this structure, wliicli accompanies most 



30 



other diseases. Its salutary tendency in 
limiting diseased action, may, I think, be 
inferred from what happens when it does 
not take place at all, or only in a slight 
degree, or where the inflammatory excite- 
ment exceeds that which seems necessary to 
the process in question ; of which erysipelas 
appears to present an exemplification. This 
may be sufficient for my present purpose; 
but no structure in the body would require 
more space for a full discussion of its sym- 
pathies, if viewed with regard to its patho- 
logical relations. 



Absorbent Glands. 

The sympathies of these parts present 
phenomena of a mixed and varied character, 
but which, to prevent repetition, may be 
mentioned in this place. Their sympathy 
with the skin is well marked and important. 
Like it, they may be considered as consti- 
tuting portals to the body ; having, in addi- 
tion to the function of absorption, that of 
staying, and perhaps modifying, any matter 
which may have been so far, admitted. The 



31 



influence of cold in causing glandular irrita- 
tion of a simple kind, or in exciting the 
peculiar action of scrophula, where there 
exists any predisposition to it, strikingly 
exempliflies this sympathy. Occasionally it 
appears in the nature of the contiguous 
sympathy of Mr. Hunter ; as when the 
glands of the neck inflame in consequence 
of cold applied to the skin covering them, 
or in its immediate vicinity. 

Often enough, however, the exciting 
cause is distant ; as where inflamed glands 
occur from wet feet : or general, as when the 
whole skin has been affected by cold and 
moisture. The sympathy of absorbent glands 
with diseases in their neighbourhood is very 
constant ; but it is characterized by differ- 
ent actions in different cases. Sometimes 
it appears of a specific character ; sometimes 
not. The former case suggests the pre- 
sence of the specific stimulus consequent 
on its absorption ; the latter, the commu- 
nication of irritation, either by continuity 
of surface between the gland and the ab- 
sorbents leading to it, or from a sympathy 
of parts, concurring in function, independ- 



32 



ently of such continuity. For example : a 
cancer may affect the glands in its vicinity ; 
but the action in the gland may be specific, 
or only that of common irritation. Again, 
the inflamed inguinal gland, consequent on 
irritation in the foot, by a toe-nail or other- 
wise, hardly justifies the idea of absorption 
of irritating matter; whilst the specific ac- 
tions sometimes accompaning or succeeding 
to sores on the penis, the result of external 
influence, scarcely allows us to entertain any 
other. Like all parts which I have ventured 
to call the portals of the body, absorbent 
glands have a very lively sympathy with the 
general system. Glandular irritation, how- 
ever induced, usually gives rise to constitu- 
tional disturbance; and primary constitu- 
tional disorder very commonly superinduces 
glandular irritation. This is seen in fevers, 
and in many minor derangements of the 
general health, especially those characterized 
by disorder of the digestive organs. 

Salivary Glands 
Sympathize with each other, sometimes 
by an action similar to the primary impres- 



33 



sidn ; more generally, perhaps, by an in- 
crease of their secretory function. This 
difference is seen in different cases where 
there is no cognizable difference in the 
primary impression ; say, an inflammatory 
swelling of any one of them. Their sym- 
pathy with peculiar disordered conditions 
of the system is familiarly exeniplified in 
ptyalism ; and with the stomach, in most 
conditions, whether of health or disease ; 
hunger, and sickness, especially. Had we 
the same opportunity of observing it, the 
pancreas would probably exhibit corre- 
sponding sympathies with the general sys- 
tem, and that part of the alimentary canal 
to whose functions it appears to contribute. 
The paucity or excess of salivary secretion, 
observable in different stages of various 
affections of the mouth, nose, and fauces, 
whether occurring from cold, as inflamma- 
tion, or from disturbance of the general 
health ; and the increased secretion on 
mechanical stimulation, or on mere expo- 
sure of these parts to the atmosphere, de- 
note the sympathy between them and the 
salivary glands, of a kind, analogous to that 

D 



34 



manifested by the lachrymal gland, on 
irritation., natural or otherwise, of the con- 
junctiva. The sympathy seen between the 
salivary glands (the parotid more especially) 
and the testicle, seems to me an interme- 
diate action ; the connecting links being 
the stomach, and the general disturbance 
of the constitution. That this is the chan- 
nel, appears probable from the fact, that 
the only example of it— viz. that seen in 
cynanche parotidea, or mumps — is usually 
accompanied by considerable disorder of 
the stomach and general system. The sym- 
pathy, however, is not constantly developed ; 
neither is the stomachic, nor the general dis- 
order of which I have spoken. I have not seen 
enough of this disease to say what relation 
there exists between tlie development of 
the sympathy in question, and the degree 
of functional disturbance, of which I have 
spoken. If there be a relation between 
them, it would strengthen the view I have 
suggested ; if otherwise, it would prove it 
untenable. The occurrence of it at a time of 
life when the stomach, and general system 
are highly susceptible, perhaps rather favors 
the opinion than otherwise. 



35 



Sympathies of Mechanical Relation. 
I introduce here the few remarks I have 
to offer on this division, because I can at 
no future period mention them, more con- 
veniently. The phenomena to which they 
refer, are perhaps not usually considered 
as sympathetic, in the ordinary sense of 
the term ; but, in a practical point of view, 
it appears more useful so to consider them. 
The best illustration is afforded by the 
various vascular disturbances, so frequently 
resulting from, or connected with, repletion 
of the system of the vena portse, familiarly 
exemplified in haemorrhoids, and in many 
other affections of the rectum ; but which 
seem, in many cases, no less demonstrably 
connected with hepatic disorder, whether this 
be occasioned by a loaded condition of the 
liver, abstractedly considered, or arising, 
as I am convinced it frequently does, from 
disordered action of the heart. In the 
present state of our knowledge of the func- 
tions of the liver, (between which and the 
heart I cannot help thinking that we shall 
one day discover more important relations 
than those at present known) ; it seems 
D 2 



36 



most safe to connect the sympathies of these 
organs witli their mechanical relations. 
That, disordered action of the heart, occa- 
sions hepatic congestion, by affording more 
or less impediment to the return of the 
blood through the venae cavas hepaticse, and 
that the heart, on the other hand, is often 
oppressed by the quantity (perhaps quality 
also) of blood derived from this source, is, 
I think, very evident. There are many 
phenomena which it seems impossible to ex- 
plain, on any other supposition, than that the 
liver must participate in the venous con- 
gestion which they demonstrate ; whilst, 
as regards the oppression of the heart, pro- 
duced through the liver, the evidence is 
frequent and striking ; and I believe that 
at least some of those cases of palpitation, 
which are referred to dyspepsia, might with 
more propriety be referred to the source 
to which I am alluding. In many instances, 
where disturbance of the heart has accom- 
panied general disorder, nothing gives so 
decided relief as producing copious biliary 
secretions ; and this too, where direct de- 
pletion seems rather to aggravate the sym- 



37 



ptoms in question. I know a case, where, 
with an exceedingly disturbed state of the 
nervous and vascular systems, in which the 
heart was so irritable, that even rising from 
a seat, would increase its beat from 20 to 30 
in a minute, nothing appeared to give relief 
but calomel, in occasional doses, which al- 
ways increased the biliary secretion ; except, 
occasional discharges of blood from the 
rectum, which always produced equal be- 
nefit ; the pulse becoming not only nearly 
natural, but remaining for some time steady 
and inexcitable. I am not desirous of ex- 
panding this argument ; for, after all, my 
wish is, as I have before observed, to make 
an arrangement, which shall conveniently 
register the connexion of different parts, 
rather than have any pretension to a perfect 
classification, scientifically considered. Al- 
though the facts which I have mentioned, 
in the effusion taking place from serous 
membranes, are vital phenomena ; yet 
that turgescence of vessels, which gives 
rise to them, is in itself mechanical : and 
I just revert to it in this place, as conve- 
nientlv impressing the connexion of these 



38 



parts with the organs with which they are 
in mechanical relation. 

The sympathetic affections of the uterus, 
rectiun, and bladder, though offering doubt- 
less some objection to it, seem, for prac- 
tical purposes, most advantageously includ- 
ed in this division. 

The disordered actions of the uterus, 
as shewn in deficient, disordered, irregular, 
or profuse catamenia, excited by irregularity 
of the bowels, and relieved by attention to 
the regular performance of their functions, 
constitute cases of almost daily occurrence ; 
and it is very frequently demonstrable, that 
these disorders are excited by accumula- 
tions in the lower bowels. The sympa- 
thetic irritability of the bladder, in uterine 
affections, is also well known. The sym- 
pathy of the bladder and rectum, in the 
male subject, — parts involving so many 
important considerations in surgery, — seems 
best arranged in this place. I intended to 
have considered it in another section ; but 
simplicity of arrangement induced me to 
abandon that intention. Were I to illus- 
trate the sympathy occasionally seen be- 



39 



tween the urethra, bladder, and rectum, in 
the male subject, I should have to write 
treatises on their respective diseases ; for 
there is not one which does not, in some 
way or other, manifest this sympathy. 
Irritation in the urethra, stricture, affec- 
tions of the prostate, and stone, shew the 
power of the urinary apparatus in produc- 
ing irritation, or even prolapsus of the rec- 
tum. Haemorrhoidal tumors, irritability of 
the sphincter ani, stricture, whether simple 
or malign, shew the power which affec- 
tions of the rectum, exert in disturbing the 
urethra, prostate, and bladder. 

I may remark here, that many organs, 
whose relations to the heart, present ob- 
jections to their sympathies with it being 
classed in this division, still, often appeal 
to have them excited, by means of their 
mechanical relations. I allude to the in- 
stances, in which they are developed by 
influences, which act primarily, by disturb- 
ing the general circulation. The brain, for 
example, especially if there be any predis- 
position to cerebral disturbance ; as is seen 
in certain cases of apoplexy. 



CHAPTER III. 



FUNCTIONAL DIVISION. 

Identity, community, or concurrence 
of function, seem to offer another, conve- 
nient basis for classification. 

Alimentary Canal, 

The sympathetic connexions of the dif- 
ferent parts of this tube have been alhided 
to in the Structural Division ; they may be 
further impressed here. 

The sympathetic disturbances of this 
canal are best marked in affections of its 
extremities. For example, in that disorder 
of the stomach, and the whole assimilating 
functions, which results from disorder or 



41 



disease in the rectum ; and which is ob- 
served in haemorrhoids of different kinds, 
irritating descents of small portions of the 
bowel, abscesses, stricture, or mere irrita- 
tion. These maladies, though offered to us 
usually as primary affections, are often them- 
selves but diseased indications of sympathy 
of the rectum with the other parts of the 
canal, or with the hver. However, the 
stomachic affections are often not apparent 
until the affection of the rectum becomes 
developed ; and then, we have more or less 
in different cases ; flatulence, costiveness, 
or irritative frequency of action of the lower 
bowels, wandering pains in the colon, or 
other bowels, fitful or deficient appetite, 
and impaired digestion. 

Imperfect digestion, where more ob- 
viously the primary affection, equally affects 
the other parts of the canal. This is ex- 
emplified in the varying, vitiated and offen- 
sive nature of its secretions, in pain, in 
purged, flatulent, or costive bowels, and 
often by a disorder so general of the whole 
canal, that the original affection becomes 



42 



masked by the sympathetic general dis- 
turbance. 

The sympathy of the ahmentary canal 
with the mouth, fauces, and the nose, all 
of which have something of a concurrent 
function with it, has been already men-- 
tioned ; to which, as occasionally referring 
to these parts, as well as the gustatory 
sense, may be added, nausea. The sym- 
pathies of several parts of the alimentary 
canal might be enlarged on to any extent ; 
and much might be said on affections 
which appear as primarily affecting the 
duodenum ; but the facts mentioned are 
familiar, and appear sufficient : my present 
object is not furthered by any unnecessary 
multiplication of illustration. 

Alimentary Canal and Skin, 

These parts are, as it were, shaded off 
into each other, by that attenuated modifi- 
cation of cuticle which is seen at the points 
of communication between the external and 
internal surfaces of the body. As the two 



48 



largest absorbing surfaces in the body, 
they suggest a striking analogy in function. 
Their sympathies are familiar, constant, and 
reciprocal. Neither organ is affected with 
any disorder with which I am acquainted; 
scabies perhaps excepted, and that not in 
every case, without giving rise to, or being 
accompanied by some manifestation of this 
sympathy. As regards apparently primary 
affections of tlie aUmentary canal ; vomiting, 
purging, or pain, present the most frequent 
and famihar examples of this sympathy, in 
the varying conditions of the skin which ac- 
company them. Similar sympathetic mani- 
festations accompany almost every formi of 
dyspepsia, and that irregularity of function in 
the bowels, which either constitutes the main 
feature or contributes to form such a variety 
of apparently similar disorders. The reci- 
procity of this sympathy, excited by causes 
primarily addressed to the skin, is equally 
remarkable. It is illustrated by the sick- 
ness which is sometimes occasioned by the 
impression of severe cold; and especially 
by the various inflammations of the abdo- 
minal viscera, which are not unfrequently 



44 



consequent on cold applied to the cuta- 
neous surface. The sympathy is also well 
demonstrated by the relief afforded in such 
affections by warmth and moisture of the 
skin, however induced. 

Skin and Lungs. 

The sympathy of these parts is well 
known, and may be conveniently classed 
under the Functional Division. 

We may be said, in some sort, to breathe 
by the skin, and to perspire by the lungs ; 
though the latter seems more marked in 
some animals than in the human subject. 
Extensive burns, in the oppression which 
they produce in respiration, will demon- 
strate the sympathy between these' parts 
where the primary impression is applied to 
the skin. 

The phenomena of phthisis, where the 
primary disturbance seems to take place 
in the respiratory organs, very strikingly de- 
monstrate this sympathy ; first, in the catar- 
rhal impression, so frequent at the com- 
mencement; 2ndly, in the varying condition 



45 



of the cutaneous circulation, tlirougliout tlie 
disease ; and, lastly, in the profuse secretion 
from the skin and bowels ; but always from 
the former, when the dying lung requires 
most assistance in its labour of decarbon- 
ization. 

Skin and Kidney 

Seem properly enough viewed as joint 
emunctories of the body. 

All affections of the kidney produce very 
obvious phenomena in the skin ; evinced by 
varying states in its circulation ; in its sensa- 
tions, as those of heat, cold ; and both in the 
quantity, and, in some cases, quality, of its 
secretions. In severer forms of the disor- 
der of the kidney, the sympathy of the skin 
becomes very remarkable ; as in its attempts 
at vicarious secretion, in suppression of 
urine, in the rigors, as also in that exsan- 
guous horripilation, which accompanies the 
miore severe stages of calculous or renal dis- 
orders. Impressions primarily addressed to 
the skin, equally evince the sympathy in 
question, whilst they demonstrate its re- 
ciprocity. Sudden change of temperature 



46 



invariably affects the kidney ; so does the 
gradual check of perspiration. Another 
illustration is afforded by the varying quan- 
tity of urine, in winter and summer: and the 
well-known consequence, of the old school 
trick, of dipping a sleeping school-fellow's 
hand in water, is by no means a bad example 
of the same sympathy. 

Skin and Heart 

The sympathy between the heart and 
vascular system, and the skin, seems con- 
veniently enough arranged in this division. 

The heart and skin, placed as it were at 
remote points of the circulation, exhibit 
their sympathy most commonly in actions 
which have a manifest tendency to preserve 
its equilibrium. 

If the heart be excited, we soon perceive 
the skin participate in this action ; if it be 
continued or violent, the skin pours forth 
its secretions, and thus diminishes the cir- 
culating fluids. W alking, running, or any 
thing which excites the circulation, exem- 
plifies this sympathy. The proximate link 



47 



with the skin, in the act of blushing, seems 
to be its sympathy with the heart ; thoiigli 
this by no means satisfactorily explains this 
interesting phenomenon. The influence 
produced on the heart by the passions, pro- 
duces similar affections of the skin. Anger, 
if it excite the heart, produces increased 
vascular action on the skin ; if it depress 
the heart, which it occasionally does when 
it is extreme, it produces paJlor. Should I 
have included these phenomena in the list 
of those of mechanical relation ? — it ap- 
pears to me not. The profuse and sudden 
bursting forth of cutaneous secretion in 
sudden oppressions of the heart, in palpita- 
tion, whether the consequence of temporary 
functional disorder, or during those pa- 
roxysms which take place every now and 
then during organic diseases, well marks this 
sympathy. The relief which it so com- 
monlj^ affords, equally tends to press it on 
our observation. 

Impressions primarily addressed to the 
skin, equally affect the heart ; depressing 
influences, if slight, and of short duration, 
produce a reaction of the heart ; if they be 



48 



continued, so as to depress the powers of 
the skin, the heart becomes depressed also. 

Nothing more famiharly exempHfies this 
influence than tlie varying states of the cir- 
culation during hot or cold weather, accord- 
ing to its degree, or the duration of its 
influence. 

Many affections of the skin, common to 
it and the cellular tissue, and which are re- 
lieved by means primarily directed to the 
digestive organs, seem to consist of endea- 
vours on the part of the skin to relieve a 
loaded state of the circulation. Boil, car- 
buncle, many cases of erysipelas, and many 
affections of the skin of a tubercular cha- 
racter, appear examples of this ; but it must 
be remarked, that mere repletion is seldom 
the only fault in such cases. 

I have a verv interesting: case at this time 
under my care, where a disordered state of 
the circulation, with a tremulous condition 
of the right arm, allied to paralysis, seems 
to have been checked by a spontaneous 
eruption of a tubercular character on the 
nates. 

The decarbonizing function of the skin, 



49 



wliich suggests a relation with the heart, so 
far, similar to that which exists between the 
heart and the lungs, may possibly have some 
influence in the ready sympathy which ex- 
ists between the parts in question. 

Of the Sympathy of the Skin with its several 
Parts. 

This is a sympathy, which, though very 
familiar, has not, I think, been regarded with 
the attention it deserves ; for, as I shall 
hereafter endeavour to shew, it exercises a 
very important influence in the causation of 
diseases. It will be sufficient to mention, 
that cold, applied to a very small district of 
the skin, is frequently capable of impressing 
the whole of this immense surface with a 
corresponding sensation ; and that warmth, 
partially applied, frequently difflises warmth 
over the whole organ. Irritants also, of 
various kinds, applied to a small district, 
will frequently produce an extension of their 
effects over a very large surface, or even, 
with intervals, over the whole body : as is 
sometimes seen in the extension of the ef- 

E 



50 



f ects of the tartrate of antimony, and in the 
boils which occasionally succeed to the ap- 
plication of blisters. No part has more 
extensive sympathies of every kind than 
the skin ; those of the stomach itself, which 
Mr. Hunter has called the centre of sym- 
pathies, are not at all more important. The 
skin has a sympathy with every part ; and 
this so direct, that it is difficult to trace 
any intermediate agent. Whether it cover 
muscle, bone, tendon, ligament, or the 
mixed structure of joints ; whether it be 
divided from parts merely b}^ cellular tissue, 
as more frequently is the case, in these ex- 
amples ; or by a thick stratum of different 
structures, and those even not directly con- 
tinuous with the part beneath them ; as 
in the chest and abdomen ; or when even 
bone be added to these media, as in the 
cranium; both the diseases, and the reme- 
dies we employ for them, alike demonstrate 
the universality of the cutaneous sympathy. 
Without unnecessarily enlarging on the sub- 
ject, it may be at once observed, that our 
local applications in the head, chest, and 
abdomen, thougli partially otherwise ex- 



51 



plicable, present many occurrences which 
can be alone referred to this sympathy. 

Illustrations are seen — in the effects of 
given degrees of topical, as compared to 
general bleeding ; in local excitements, as 
compared to general ; in the phenomena of 
counter-irritation, especially where these 
refer to the chest or abdomem ; and in 
many other phenomena. 

The sympathy of the skin with the kid- 
ney has been already mentioned. With no 
part is it more marked than with the whole 
of the urinary organs ; but the phenomena, 
as presented to us in the histories of stric- 
ture, and irritable bladder, are so familiar as 
to render a mere allusion to them sufficient. 
I cannot, however, avoid making particular 
mention of the various eruptive and ulcer- 
ative affections observable on those parts of 
the skin which are contiguous to its point 
of involution, as I may term it ; or its con- 
nexion with internal canals, exemplified in 
affections of the lip, of the margin of the 
anus, and in the numerous sores consequent 
on irritable urethra. The extensive sym- 
pathies of the skin are equally observable 
E 2 



52 



in other animals, whilst they have been 
turned to much greater practical advantage 
in the prevention, if not in the removal, of 
diseases. 

Heart and Kidney. 

As connected with a preservation of 
equilibrium in the circulation, the sym- 
pathy between the heart and kidney may 
be ranged as functional. 

There is scarely any affection of the 
heart, however slight, which does not pre- 
sent some little tendency to produce sym- 
pathetic actions in the kidney ; especially 
where these impressions are addressed first 
to the nervous system, as seen in fear or 
temporary kinds of anxiety. It should be 
observed, however, that the impressions on 
the nervous system have the power of di- 
rectly influencing the kidney, without any 
intermediate affection of the heart, so far at 
least as can be ascertained ; but still this 
seems to be the exception. Different de- 
grees of mental solicitude produce this 
effect. All serious affections of the heart 
are attended by marked sympathy in the 



53 



kidney, although they are various in their 
nature, and in many instances unintelligible. 
For the most part, they act as relieving the 
circulation, by either a loaded condition, or 
what is more common, by an increased 
quantity of urine. 

The varying state of the skin in affec- 
tions of the heart may very possibly influ- 
ence this sympathy, either in increasing the 
actions of the kidney where the circulation 
of the skin has become depressed, or in 
diminishing the secreting actions of that 
organ, where those of the skin have been 
abundantly excited. There is scarcely any 
affection of the heart in which these states 
are not exemplified. The peculiar charac- 
ter of the urine in some affections of the 
vascular system, as where it contains large 
quantities of albumen, are further proofs of 
the sympathy between these parts ; but the 
action itself, so far as I know, has not been 
satisfactorily explained. 



Heart and Limgs. 



Reoarded as concurring: in the function 
of the distribution of aerated blood to the 



54 



body, I mention the sympathy of the heart 
and lungs in this place. 

This might, perhaps, for mere purposes 
of arrangement, have been mentioned in 
connexion with sympathies of mechanical 
relation ; but where any correspondence or 
concurrence of function is obvious and fa- 
miliar, it seems a preferable association. 
The sympathy between the heart and lungs 
seems sometimes to be excited by causes of 
a chemical, at others, by influences which 
are of a mechanical kind. Perhaps, when 
the lungs affect the heart, it may be the 
former ; the lungs not having effected, or 
only partially, the required change in the 
circulating blood. On the other hand, when 
the heart affects the lungs, it is usually by 
the quantity of the blood, or the unnatural 
impetus with which it is transmitted ; this 
being too great, not sufficient, or irregular. 
As the heart seems much more easily ex- 
cited, and as it is subject to a great number 
of primary impressions — of amoral kind, for 
example, — from which the lungs are compa- 
ratively exempt, the heart in health more 
frequently affects the lungs. The sympathy 
developed by disease, more frequently takes 



55 



place, perhaps, in the opposite direction. 
This, however, is too extensive a subject to 
enter on ; neither is it necessary to the ob- 
ject of this paper. The sympathy is fa- 
mihar. On a careful consideration of the 
whole subject, I cannot attach much im- 
portance to the nervous connexions as ex- 
plaining these sympathetic relations. Parts 
placed near each other afford examples 
of nervous as well as of vascular communi- 
cations. 



Liver and Bozvels» 

The sympathies of these parts must be 
regarded as functional. The bile seems to 
contribute a natural stimulus to the intes- 
tines, inducing the discharge of excremen- 
titious matter, of which it seems, in some 
degree, to form a part. The regularity of 
the bowels, every body knows, is materially 
influenced by properly regulated discharges 
of bile. Costiveness is almost the invaria- 
ble result of deficient biliary secretion. It 
is not quite so frequently remarkable, but 
nevertheless is true, tliat disorder, not dis- 



56 



tinguishable as other than primary in the 
bowels, is equally capable of deranging the 
functions of the liver. This is best seen in 
cases of mechanical obstruction, and in 
those cases where sedentary habits or ne- 
glect in attending to the calls of nature, 
have produced a state of bowels and liver 
in which the evidence is sometimes par- 
ticularly clear as to the priority of the 
affection of the bowels*. I shall hereafter 
remark on the advantages which result from 
the recollection of the reciprocity of this 
sympathy. 

Stomach and Liver. 

The concurrence of these organs in the 
general function of assimilation, however 
far we may be from understanding the 
precise part played by the liver, cannot be 
doubted. The attacks of biliary disorder, 

* I was called the other day to a case of extremely pain- 
ful affectioD of the rectum, accompanied by much vitiated 
condition of biliary secretion, and which the history of the 
case prov'es, I think, very clearly to have been a secondary 
disorder. 



57 



derived through the stomach, as well as 
those of stomachic irritation, apparently 
dependant on primary biliary disorder, 
are too common to require particular 
mention. 

These cases also frequently shew, in the 
remedies which are employed, the advan- 
tages of recollecting the reciprocity of the 
sympathy. Once and for all, I may remark, 
that it is extremely difficult to say, in a 
given case, which organ shall have been 
primarily affected where two or more are 
simultaneously deranged, or even where the 
derangement of one only, is observable. 
It has already been remarked, that the 
sympathetic affection is sometimes more 
prominent than the primary impression, 
sometimes less so ; to which may be added, 
that sometimes the primary action alto- 
gether subsides on the appearance of the 
secondary sympathetic affection, of which 
local diseases afford numerous illustra- 
tions. The history of the case, however, 
if it be examined with the requisite labour, 
and laborious this examination often is, 
will generally enable us to detect the order 



58 



of derangement of the respective organs, 
for practical purposes, with sufficient ac- 
curacy. 

Urethra^ with Urinary and Genital Organs, 

The sympathy evinced by the different 
portions of urethra with each other, are well 
shewn in the " Irritable Urethra," and es- 
pecially wliere the part affected is its pros- 
tatic portion. 

The disturbance excited by the urethra, 
in many cases, in the functions of the blad- 
der, kidney, and testicle, are well known ; 
but, as regards their degree, or their excita- 
bility, these sympathies are not reciprocal. 

The testicle exhibits a very ready ten- 
dency to sympathize with the urethra, both 
in diseases of an acute and chronic form. 
This is exemplified — in hernia humoralis, 
in common inflammation ; in chronic en- 
largements, and in hydrocele ; all of which 
frequently occur from urethral irritation. 
The urethra, however, very rarely sympa- 
thizes with the testicle in accidents or dis- 
eases jjri7narili/ impressed on that gland. 



This absence of reciprocity is observable, 
though perhaps not in the same degree, in 
the sympathetic relations of the urethra 
with the bladder and kidney. 

It is true that primary affections of the 
bladder and kidney do occasionally produce 
sympathetic manifestations in the urethra ; 
as in stone, for example ; 

Yet this sympathy is by no means a 
necessary concomitant to affections of either 
of these organs ; whereas there is no affec- 
tion of the urethra which does not pro- 
duce sympathetic irritability of the bladder 
in a greater or less degree ; nor any which, 
if it be long continued, does not induce 
disordered actions, and ultimately disease, 
of the kidney also. Indeed, it is to the 
neglect of advice, founded on this sympa- 
thy, that many persons perish from disease 
of the urinary organs. The accommoda- 
tion of the efforts of the bladder to the ob- 
stacles presented, by disease of the urethra, 
renders the approach of disorder insidious. 
The exhaustion of this power of accommo- 
dation gives rise to irritability and disease, 
both of the bladder and kidney, too often 



60 



beyond our power of correction. The 
greatest power of exciting sympathetic 
action, then, as regards the urinary and 
genital organs, resides in the urethra, and 
seems to result from its complexity of func- 
tional relations. This power, however, 
seems placed where it would be likely to 
be most beneficial ; that is, where external 
influences are most likely to produce nox- 
ious impressions ; and, as regards the tes- 
ticle, is obviously directly preservative. 

Had the sympathy been reciprocal, many 
variations in the state of excitement, of the 
kidney, bladder, and testicle, which, con- 
stituted as the body is, seem inseparable 
from their functions, and which now prove 
fugitive and of no import ; would, in ex- 
citing the urethra, have been (by the re- 
acting sympathy of this part) magnified 
into serious disturbances. 

The different sympathy evinced by the 
urethra, in admitting any foreign body from 
without, and in giving exit to any thing 
from within, appears to exemplify the pre- 
servative effect of that order, in its svm- 
pathetic susceptibility, which nature has 



61 



established. Considerable portions of rough 
gravel often pass outwards without the 
slightest inconvenience : the introduction 
of the softest bougie, with all proper pre- 
paration, frequently produces, as every one 
knows, considerable excitement, and gene- 
rally at first some evidence of disturbance. 

The extensive sympathies of the urinary 
and genital organs with the nervous system, 
and with the whole of the chylopoietic vis- 
cera, are well known, and may be gathered 
from almost any treatise on their diseases. 

Uter^us and Mammary Glands, 

The sympathies between these parts, 
with reference to my present object, require 
little remark ; as they are so familiarly ex- 
emplified in parturition. 

They are, however, developed in many 
morbid affections, and often present them- 
selves in conjunction with very curious and 
interesting complications, well known by 
those engaged in the practice of midwifery, 
and the diseases of women ; and which often 
unfold the extensive sympathies of the 



62 



uterus with other organs, as well as with 
those with which its sympathy is more 
commonly manifested. Examples, how- 
ever, occasionally occur, in the practice of 
surgery, of the kind to which I am allud- 
ing. 

Not long ago, I was consulted by a 
female, 31 years of age, with regard to an 
abdominal tumor, which was accompanied 
by circumstances, which, although not al- 
together unprecedented, I apprehend to 
have been rare. She consulted me in June 
last, and stated that she had been married 
about ten years, and had borne one child, 
about eight years since. She complained 
of sickness in the morning, and had on one 
occasion vomited ; but nothing more than 
a fluid, which she described to be like 
water. She began to perceive an increase 
in her size in September 1834; and this 
increase appeared to progress gradually 
until Christmas, when she had attained her 
present magnitude ; since which, she is 
positive there has been no augmentation. 
She sometimes feels a motion ; but, to use 
her own phrase, " like a little bud." The 



63 



catamenia are regular as to time, but scanty 
and pale. Examination per vaginam de- 
tects nothing peculiar : the os uteri is felt 
distinctly about as far as the finger will 
reach. It is now ten months since she 
first perceived the enlargement. The 
breasts are painful, and fuller than is usual 
with her ; a symptom which she observed 
from the commencement of the abdominal 
enlargement. There is a little fluid oozes 
from each nipple : it is like poor milk, 
blueish and semitransparent. I obtained, 
by means of a cupping glass, a very small 
quantity, which, treated by nitric acid, threw 
down a considerable quantity of albumen. 
Examination of the abdomen detects a con- 
siderable tumor, apparently higher than the 
pregnant uterus, the limits of which appear 
ill defined. It appears to emerge from the 
right hypochondrium, and to be connected 
with the liver. She distinctly states, how- 
ever, that the swelling began low down on 
the left side. She has some pain in her 
loins and head, and her feet swell occasion- 
ally. This case appears to me to involve 
considerations of interest ; but they are 



64 



foreign to my present object, and would 
lead me to an inconvenient digression. 
This woman, whom I saw only three weeks 
since, told me that, when she left me, she 
consulted a medical gentleman in her own 
neighbourhood, and that the whole of her 
ailments, the tumor inclusive, subsided on 
her bowels being much purged. On ex- 
amination, I find that the liver feels full ; 
but there is no abdominal tumor. 

This shews again the extensive sym- 
pathies of the uterus ; but these are so 
familiar, that I avoid swelling the argument 
by an unnecessarily large envimeration of 
them. 



CHAPTER IV. 



INTERMEDIATE SYMPATHY. 



Although considerations of structure 
or function present convenient bases for 
arranging many of the most important sym- 
pathies, yet there are some which appear 
to require, for remembrance and facility of 
reference, if for no more important objects, 
other divisions ; and a very useful one may, 
I think, be formed under the term of " In- 
termediate Sympathy." 



Stomach and Lungs, 

It appears that the sympathy of these 
organs cannot be advantageously referred 
either to identity of structure, or analogy of 
function, although a mucous membrane is 
found in both cases. 

F 



66 



The sympathy between them is illus- 
trated in those coughs, with increase of 
bronchial secretion, which are known, even 
popularly, to depend on stomachic irrita- 
tion, and for which emetics and abstinence 
constitute the best and most certain relief. 
The sympathy is also demonstrated in those 
disorders of the respiratory organs which 
simulate phthisis so strongly, and which are 
relieved by measures directed solely to the 
digestive organs. Of these I have seen 
examples. I have also seen them where 
no such predisposition could be detected, 
exasperated into a genuine and fatal phthi- 
sis. Between the stomach and lungs there 
is certainly contiguity of surface, combined 
with analogy of structure; and it is very 
possible that all the relations, anatomical 
and physiological, may contribute to the 
excitability of the sympathy in question. 
When, however, w^e regard the very marked 
sympathy which the stomach and lungs 
both have with the skin, and the latter with 
tliat involution of it which covers the 
throat and fauces, and when we connect 
with this, tlie invariable affection of tlie 



67 



skin whenever the stomach and lungs sym- 
pathize with each other, — I think we shall 
be inclined to consider the intermediate 
affection of the cutaneous surface as the 
more usual channel through which the 
active sympathy manifested by the stomach 
and lungs is commonly developed. The 
direct sympathy of these parts is neverthe- 
less, in some persons, very apparent, both 
in health and disease ; but it is the excep- 
tion ; and it is not my present object to 
give a complete account of the subject. 
The first impression of any one will be, that, 
which refers the sympathy of these parts to 
contiguity, continuity or community of 
structure. So was it mine ; but more 
extended considerations have induced me 
to relinquish this opinion : but there is 
no space nor occasion for the argument 
here ; the only material thing being the 
fact of the sympathy between the parts, 
which is well known, and demonstrable in 
asthma and many other disorders. 

It has occurred to me, to witness seve- 
ral cases illustrative of this sympathy ; and, 
although it is now so well established, I 
F 2 



68 

will just allude to the case of a young lady, 
who had some very alarming symptoms 
referred to her respiratory organs, and 
which were not the less so, from the cir- 
cumstance of her father having died of 
phthisis. She had had medical advice ; 
but, getting no better, her friends deter- 
mined on consulting a surgeon, and they 
brought her to me. The expectoration 
was very copious, and for the most part 
mucous ; but it was intermixed with a 
matter evidently puriform. Her stomach 
and bowels were much disturbed, and the 
secretions were very unhealthy. I told her 
that 1 had no faith in medicine doing her 
any good, until she had a better tongue, 
and her bowels were more regular ; but 
that, such improvement taking place, then 
medicine might be beneficial. However, 
when the secretions became improved, pain 
ceased, and the expectoration nearly sub- 
sided ; and, there being no other symptom, 
but a very slight cough, I recommended her 
to continue her diet, to avoid taking me- 
dicine, except such as might be necessary 
to ensure regular actions of the bowels. 



69 



and to go into the country. I recom- 
mended the Isle of Wight ; but it happen- 
in to be more convenient for her to oo 
some 100 miles north, I consented, on con- 
dition that, should there be any recurrence 
of her pulmonary symptoms, she should 
return. In a very few weeks she got per- 
fectly vv^ell ; and, I have reason to believe, 
remains so at the present time. The fore- 
going occurrences happened some years 
ago. I could mention many similar cases 
which have come to my knowledge ; but I 
regard it as unnecessary. 



Liver and Lungs, 

A marked sympathy is often exhibited 
between these viscera ; and although it 
takes place in various ways, yet, perhaps, 
as often as any, through the medium of the 
diaphragm ; and also through the head, 
stomach, and skin. Sometimes either 
through the quantity of blood, or its qua- 
lity, or from other causes, the sympathy 
occurs in a very direct manner. 

It is not often we see the lungs affected 



70 



without more or less derangement of the 
liver ; nor the liver materially disordered 
without oppression of the respiratory or- 
gans. Their mechanical relations exert 
considerable influence in exciting a mutual 
sympathetic recognition of disturbance. 

The cases exemplifying this sympathy 
are I believe common. I know a gentle- 
man who has phthisis in his familyj and 
to which he appears to have some pre- 
disposition himself ; having been at one 
time much subject to attacks of dyspnoea, 
with pain and cough. These, however, are 
always very evidently excited under either 
the remote or proximate influence of dis- 
order of the digestive organs, the liver 
generally being the primary offender. His 
relief by biliary discharges is uniform. I 
recollect visiting him once when he was 
labouring under an attack of more than 
usual severity ; and when, although he was 
in all respects better, his cough was still 
very troublesome to him, and a source of 
anxiety to his medical attendants. He 
took several forms of medicine, as sudo- 
rifics, antimony, calomel, and opium, with- 



71 



out effect. His cough, however, was in- 
stantly reheved, and his nights, which had 
been nearly sleepless, rendered good, on 
procuring copious biliary secretions, by a 
few doses of calomel with the extract of 
colocynth. 

Diseases of the lungs and liver some- 
times, as is well known, extend to each 
other through the diaphragm. I recollect 
a poor boy, whose case was an interesting 
example of this. He applied at the Dis- 
pensary with a large abscess in the right 
side, evidently in connexion with a diseased 
liver. It had existed several months ; and 
he was so reduced in strength, that I could 
hold out no hope to his parents as to his 
recovery. Nevertheless, he improved so 
much under treatment directed to the im- 
provement of his general health, and to 
the prevention of any confinement of mat- 
ter, that I began to think he might possibly 
get well. The last time I saw him, I ob- 
served that he had become worse : his 
countenance looked contracted ; and his 
mother said that he had coughed up 
matter. The poor fellow died shortly after ; 



72 



examination discovered an immense abscess 
of the liver, communicating with a con- 
siderable cavity in the right lung. I do 
not, however, mean to represent this, more 
than other sympathies^ as constant : for I 
recollect, about the same time, the case of 
a man, in whom the discharge from an ab- 
scess, connected with a much diseased liver, 
was more like a decoction of oak bark 
than any thing to which I can compare it ; 
but he scarcely manifested any distress in 
his respiration. 



Stomach and Kidney. 

The sympathy between the stomach 
and kidney seems to be referrible, ordina- 
rily, to the intermediate link which the 
skin forms between the respective organs. 
As an emunctory, the kidney and bowels 
have a functional relation, which is seen in 
very active operation, in many cases of de- 
ficient action of the bowels, in the exceed- 
ingly loaded condition of the urinary secre- 
tion : and with the stomach, the sympathy 
of the kidney, as well as that of the bladder. 



73 



is sometimes so rapid and remarkable, as 
scarcely to suggest any intermediate agency. 
It cannot indeed be doubted, that direct 
sympathy may take place between any two 
organs in the body ; but the practical object 
is to ascertain the road by which this sym- 
pathy ordinarili/ travels ; for analogy would 
rather suggest, that sympathy may seldom, if 
ever, be left to depend on a single connec- 
tion, unless we regard that as such, which 
is established in the communication of all 
parts of the nervous system with each other. 
But I say again, the usual mode in which 
a given sympathy acts, is the first and most 
material object to discover ; and which con- 
stitutes the most useful reference for us, in 
a profession where so much is often required 
under circumstances very unfavorable for 
reflection. 

It appears to me, then, that the sym- 
pathy of the stomach and kidney usually 
takes place through the skin ; since I know 
of no sympathy between them, in which the 
skin does not participate ; although the 
manifestation afforded by the extreme links 
of this chain — that is, stomach and kidney — 



74 



is generally so i^rominent, as to excite little 
attention to the intermediate connexion. 
In sudden affections of the kidney from 
stimuli, as well as other matters, taken into 
the stomach, the individual scarcely ever 
fails to recognize concomitant sensations of 
the skin, when his attention has been di- 
rected to it. In severe nephritic disorders, 
the affection of the stomach is so promi- 
nent, as to excite little observation of the 
skin ; which, however, will always be found 
sympathizing in the most active manner. 



Stomach and Heart. 



The sympathy between these organs is 
frequently, I think, direct ; and is very 
strikingly shewn in palpitations and other 
irregularities of the heart, clearly traceable 
to stomachic irritation ; but, at the same 
time, I am inclined to think, that, in general, 
the brain becomes intermediately affected ; 
with which organ both heart and stomach 
have so vivacious a sympathy. Examples 
of this sympathy need not be quoted. The 



75 



relation between the brain and stomach is 
known to every one ; and the uniform par- 
ticipation evinced by the heart in the ex- 
citement, or depression, of the brain, is 
equally familiar ; and as we almost never 
see a sympathy taking place between the 
stomach and the heart, even in the ordinary 
effect of a common repast, without the brain 
affording some evidence of its participation 
in the excitement or depression, as the case 
may be, — so it appears to me more con- 
venient, if not more correct, to place it in 
the catalogue of Intermediate Sympathies. 

Stomach and Testicle. 

I regard the sympathy between the 
stomach and testicle as one of intermediate 
agency ; the agent being the nervous sys- 
tem, or the constitution generally, which 
sympathizes vivaciously, with both organs. 

I prefer this view to that suggested by 
the rapidity of its action, and which would 
regard the sympathy between these organs 
as direct. First, because sickness of the 
stomach and various affections of the tes- 



76 



tide occur singly without developing this 
sympathy. 

Affections of the stomach affect the con- 
stitution ; even yet the sympathy is not 
developed. 

Now, wherever the constitution partakes 
in any marked degree with disturbance of 
the testicle, the stomach invariably sym - 
pathizes ; but then it does so no more with 
the testicle than it does with other parts, 
where the primary and injurious impression 
is sudden, and where it is applied to parts 
capable of disturbing the constitution. 

Injuries to the brain, blows on the ab- 
domen, accidents to joints, lacerations of 
muscle, severe blows in different individuals, 
produce sickness. It is true that sickness, 
though an extremely common consequence 
of such accidents, does not invariably suc- 
ceed to, or accompany, them : but this ex- 
ception is equally true as regards the tes- 
ticle ; for many have suffered blows on the 
testicle, and some have even nearly fainted 
without any accompanying sickness having 
been produced. 

Why the sympathy is not reciprocal, 



that is, why the stomach does not equally 
affect the testicle, is of course a separate 
question, in no way necessarily connected 
with that question which considers the 
mode by which the testicle affects it. Other 
examples of this want of reciprocity occur, 
equally inexplicable ; as the sympathy be- 
tween the stomach and the uterus. The 
stomach and testicle, then, have a power of 
affecting a common centre, the nervous sys- 
tem ; and this may be heightened by their 
mutual power of afiecting the mind ; the 
one by the medium of the passions, and the 
other, by a mode which will be adverted to 
in the sequel. 

Tlie Syjnpat/uj bekceen the Siomacli and 
Uterus^ 

Seems very much of the same nature 
as the sympathy last mentioned ; for, al- 
though the sympathy is very rapid, it still 
seems hardly ever to be excited but through 
a genera] affection of the nervous system. 

As a whole, the uterus in the female 
appears to have a much more active sym- 



78 



pathy than the testicle in the male subject. 
The most interesting examples of the sym- 
pathy of the stomach with the uterus occur, 
perhaps, during utero-gestation, and are not 
only ascribed with confidence to a direct 
sympathy, but regarded as an unavoidable 
occurrence. As my experience of such 
cases must be very limited, when compared 
to that of gentlemen engaged in the prac- 
tice of midwifery, I wish to be understood 
as speaking cautiously, and only referring to 
my own impressions. I will therefore only 
observe, that, engaged all my professional 
life in public employments, which have 
annually brought me in contact with many 
hundreds of charity patients, I have seen a 
great many women during the period of 
utero-gestation ; and, with regard to the 
distressing state of stomach, which in too 
many accompanies that process, I have 
never seen it without very marked disturb- 
ance of the nervous system. Utero-gesta- 
tion itself, indeed, commonly renders the 
nervous system unusually alive to impres- 
sions of all sorts ; and this is frequently 
increased by absurd notions with regard to 



79 



diet, which women often entertain, and 
which leads to a state of repletion, at tlie 
very time, of all others, when the avoidance 
of extremes of any kind is most desirable. 
The nervous system thus (partly, perhaps, as 
the result of the excitement natural to utero- 
gestation, or still more from that derivable 
from avoidable sources) becomes in a state 
highly favourable to the development of 
any sympathy, which, as in other cases, will 
occur between organs most disposed to 
sympathize with each other, or most closely 
so connected with a common centre. The 
latter fact applies with especial force to the 
connexion of the stomach and uterus with 
the whole nervous system ; and the whole 
subject of the sympathy of these organs 
appears to me to open a very interesting 
field for investigation ; but this must be 
done in a work devoted professedly to in- 
dividual sympathies, and should, I think, 
be attempted by some one engaged in the 
practice of midwifery. 



80 



Uterus and Kidney 

Appears generally as an intermediate 
sympathy, sometimes through the bladder, 
but more usually by the effect which the 
uterus produces on the nervous system ; 
through which, either directly, or by the in- 
termediate agency of the skin, the kidney is 
so readily excited. Accordingly, in most 
cases of uterine disturbance, we find simul- 
taneous irregularities in the function of the 
kidney : that organ at one time pouring 
forth increased quantities of limpid fluid ; 
at others, affording a more scanty excretion 
of thick, turbid, or loaded urine. 

Of Anomalous Sympaihies, 

The chief interest which, in the present 
state of our knowledge, is attached to the 
subjects referred to the heading of this 
chapter, arises from the evidence which the 
phenomena afford — 1st. that however na- 
ture may usually have regulated the ordinary 
sympathetic manifestations of the different 
organs in the body ; j^et that, under pe- 



81 



ciiliar circumstances, any two parts, may 
sympathize with each other. 2ndly. That 
any explanation of the sjanpathies which has 
hitherto been attempted, except that which 
refers them generally to that connexion, 
of all parts, established in the nervous sys- 
tem, is inadequate to the explanation of the 
phenomena ; and, thirdly, that in the pre- 
sent state of our knowledge, any arrange- 
ment of the sympathies must be purely 
artificial ; and though very useful, perhaps, 
in pointing out which the rule, and which 
the exception ; and as combining with the 
phenomena, certain important relations 
which exist in the parts between which 
they occur ; still, that all this is only to be 
reo-arded as an arrano;ement founded on the 
usual order of the phenomena, and not as 
on any ascertained law, regulating their pro- 
duction. That though an arrangement may, 
for practical purposes, be a convenient ap- 
proximation to the truth, yet that, in its ap- 
plication to disease, it is to be regarded as 
subject to exceptions, which may be distant 
in their intervals, and few in their number, 
in tlie experience of one man, whilst tliey 

G 



82 



may occur frequently in the experience of 
another. Having premised so far, I will, 
before I consider the brain, give a few 
illustrations of the exceptions to which I 
refer. 

Any one organ, in a particular case, may 
take the lead, in its sympathetic relations, 
with all others, whether brain, thoracic or 
abdominal viscera, urinary or genital organs, 
or any other structure ; and, accordingly, 
we find people with corresponding differ- 
ences in their susceptibilities ; differences 
as to their weak parts, as it is sometimes 
expressed. I have endeavoured to illustrate 
the ordinary sympathetic tendencies in 
many important organs already, as that of 
the uterus with the stomach, for example ; 
but there are many women in whom the 
sympathy of the uterus with the brain is 
much more remarkable ; and yet in whom 
there is very little, if any, affection of the 
stomach. So with the stomach: ordinarily^ 
nothing perhaps is so common, as the sym- 
pathy of the head when the stomach is 
primarily disordered ; yet I have known 
persons who scarcely knew what head-ache 



83 



was, but wliose stomachs were often dis- 
ordered nevertheless ; derangements of 
that organ affecting the hver first, in one, 
the bowels in another, the kidney in a 
third ; and similiar varieties may be re- 
marked in the sympathies of other organs 
in different individuals. No one cause 
is so productive in the development of 
anomalous sympathies, as disorder of the 
digestive organs ; the interminable variety 
of sensation arising from this source alone, 
would, in a lecture expressly on sympathy, 
form a curious and lengthy catalogue. Some 
kinds of food, wholesome to the majority, 
prove very injurious to particular persons. 
Good potatoes, for example, are in general 
very wholesome and nutritious ; yet there 
are persons who cannot eat them. I know 
many persons who are obliged to avoid this 
root ; and a learned physician of this town 
told me he could never touch them. 

Sympathies, sometimes of an unusual 
nature, result from disease. Mr. Hunter 
mentions the case of a lady who burnt her 
neck ; and whenever she afterwards drank 
warm liquids, she felt pain in the cicatrix. 
G 2 



84 



I had a case of a young woman under 
my care, with a curious affection of the 
bladder, in whom, eating potatoes always 
produced a paroxysm of suffering. There 
is a man now in the Dispensary, in whom a 
remarkable sympathy is developed between 
the absorbent glands and the testicle. He 
had a cluster of enlarged absorbent glands 
down his neck, for which he was treated, 
first, by attention to his general health, and, 
subsequently, by mercury and iodine. The 
large tumor formed by these glands un- 
derwent no change from the remedies 
employed ; at length he complained of 
uneasiness in his left testicle, which, on 
examination, proved to be considerably en- 
larged. He did not suffer much pain, nor 
was the testicle very tender. The glan- 
dular tumor in his neck now began to 
diminish very rapidly ; and when it had 
nearly disappeared, the testicle began to 
subside also ; and they had both nearly 
disappeared when I last saw him, which is 
about ten days ago. 



85 



Of the Sympathy manifested by the 
Countenance, 

I cannot refrain from observing, shortly, 
on that universal sympathy which is so 
often depicted in the countenance ; and 
which, by the experienced or discriminat- 
ing, is justly regarded as so important an 
indication; sometimes of the nature of the 
malady, but always of the impression it is 
making on the constitution. 

Mr. Hunter attached great importance 
to this sympathy, and seems even to have 
thought that connexions might be traced 
between particular expressions, and particu- 
lar diseases. 

I am not aware that we have made 
much progress in the analysis of morbid 
expression ; yet experience gives every one 
more or less power of judging of a pa- 
tient, by the countenance ; and we find our- 
selves sometimes doing it involuntarily, 
where the symptoms, in the abstract, rather 
contradict the hope, or despondency, which 
the expression of the features suggests to us. 

The assistance, aftbrded by the expres- 



86 



sion of the countenance in the diagnosis of 
disease, seems best exemphfied in dis- 
eases of the heart, lungs, and hver, and 
in the pecuKar sallow, half-anxious coun- 
tenance which accompanies malignant mala- 
dies. 

But if the assistance supplied from 
this source be limited in regard to dia- 
gnosis, I scarcely know any malady in 
which, with a commonly discreet atten- 
tion to concurrent circumstances, our pro- 
gnosis is not materially assisted by it ; 
and if a careful observation of all the cir- 
cumstances shall have placed our minds in 
a balance, I am disposed to think that the 
prognosis may often be safely determined, 
by the manner and expression of the 
patient. 

In some instances, we may even do 
more than this ; for I have often, in com- 
mon, no doubt, with most other surgeons, 
predicted recovery where the countenance 
has been propitious, under circumstances 
where the symptoms, abstractedly consi- 
dered, would by no means have justified a 
favourable prognosis ; and have, on the 



87 



other hand, foreseen faiku'e where, the ex- 
pression of the countenance excepted, the 
patient could not be said to have scarcely a 
bad symptom. Physicians have, from the 
earliest times, been aware of the importance 
attached to the expression of the face ; 
nothing, however, impresses it more strongly 
than the practice of surgery; and especially 
the cases of patients who have either met 
with serious accidents or undergone severe 
operations. The alarm spoken of by Mr. 
Hunter, is frequently depicted strongly 
in the face of the patient ; so is anxiety ; 
so is a more modified degree of it, as ma- 
nifested by hope ; or by solicitude for re- 
covery. The two former are usually, bad 
symptoms ; the two latter may be regarded 
as favourable. 

There is a state, after operations, some- 
times, which is very peculiar and uncom- 
plaining ; but which is, in general, too sure 
a forerunner of sinking power. The pa- 
tient's countenance is, in general, somewhat 
shrunk, and his eye is either inexpressive, 
or denotes a kind of latent anxiety. He 
complains of no pain ; is not particularly 



88 



restless ; nay, sometimes will have some 
comfortable sleep ; at its commencement; 
the pulse may afford no remarkable indica- 
tion, nor does the wound always exhibit 
evidence of the real state of things. The 
state is, in fact, merely characterized by a 
certain indifference, a listlessness, a want of 
interest ; nevertheless, he is dying, which is 
too soon demonstrated. If such a patient 
recover, it is generally by the early admi- 
nistration of supporting measures. 

Whatever tact is to be obtained in this 
way, can be acquired by observation alone. 
But, in addressing students, I would caution 
them from adopting a habit, in examining 
a patient's countenance, from which I have 
observed some distinguished men not to 
be exempt, and which is very unnecessary, 
whilst it is equally at variance with good 
tact, and good breeding. I allude to that 
determined gaze, that riveted look, and 
even, sometimes, that knitting of the eye- 
brow, which, either separately or conjointly, 
characterize the expression of the exami- 
nator. It is unnecessary, because the most 
careful observation of your patient's face is 



89 



perfectly compatible with the preservation 
of the composure of your own. It is bad 
tact, because it alarms some patients, and 
may induce others to put on a factitious 
cheerfulness. That it is bad breeding, re- 
quires no illustration. 



CHAPTER V. 



THE BRAIN. 



The ordinary manifestations of the ce- 
rebral sympathies^ evince such universahty 
of connexion, and such varieties in the 
mode of their development, that to place 
the brain in any particular class appeared 
to me objectionable ; I have therefore pre- 
ferred making the very few remarks I have 
to offer, with regard to it, in a distinct sec- 
tion. 

Considered in the whole of its relations, 
the brain presents sympathies far more nu- 
merous and complicated than any organ of 
the body. Presiding over the whole man, 
moral as well as physical, cognizable every 
where, yet explicable no where, its ubiqui- 



91 



tons iiifliience is equalled only by the mys- 
tery in which it is involved ; but we can no 
more be said ideally to understand the most 
simple fact in the whole history of sym- 
pathy, than we can the most complicated 
cerebral phenomenon. A careful observa- 
tion of the sympathetic manifestations of 
the brain, and the more obvious connexions 
of which they appear to afford evidence, 
seems not only to afford the best chance of 
increasing our knowledge of the subject, 
but the most likely means of supplying that 
kind of information, which our finite capa- 
cities enable us to apply to useful pur- 
poses. 

As a common centre, to which intel- 
ligence of every impression is conveyed, 
the brain holds direct sympathy with every 
molecule in the body ; and its obvious and 
visible connexion, by the arrangement of 
the nervous sy stem, with all parts, affords 
the most striking suggestion of that sym- 
pathy and connexion of all parts with the 
brain, and with each other, which an exa- 
mination of the phenomena of health and 
disease alike combine so emphatically to 



92 



establish. Viewed as the most magnificent 
portal of the body, it exhibits, in its own 
sympathies, and in those which it confers 
on other parts ; a range of power, a multi- 
plication of relation, an extent of influence, 
a complication of faculty and function, 
which render even a moderate contempla- 
tion of it, productive of peculiar emotion ; 
and which, perhaps, more than any one 
object in nature, presents, in one single 
creation, the plainest proof, the most intel- 
ligible evidence, as well as the most sublime 
example, to the natural theologian. 

Viewed in its physical relations, the 
brain sympathizes, ordinarily, more readily 
with some organs than with others ; these 
organs being chiefly those which, like itself, 
are, either in a moral or physical sense, 
especially amenable to external impres- 
sions ; and which, as such, are also portals 
to the body ; as, for example, the chylo- 
poietic viscera, skin, and heart. 

I need not point out the sympathies 
of the brain with individual organs. 

The phenomena of particular fevers, the 
influence of the brain in the type of all, and 



93 



the phenomena following its injuries, suffi- 
ciently attest the number and complexity of 
its sympathetic relations. The recognition 
of corporeal disturbances is not usually ma- 
nifested by cerebral excitement, until the 
nervous system generally, participates in the 
disordering impression ; unless from influ- 
ences, moral or physical, derived from with- 
out, and applied either directly to the brain, 
or through the media of the external senses. 
The external senses seem placed, as it were, 
intermediately between the corporeal or 
nervous, and the moral or perceptive, func- 
tions of the organ. They seem to have cer- 
tain sympathies with the body, with the mind, 
and with each other. These sy mpathi es alone, 
would furnish a very wide field of enquiry. 
I can only here mention a few familiar facts, 
in connexion with this interesting subject. 



Examples of the Si/mpatJiies of the External 
Senses xmth the Body. 

Many odours produce head-ache ; so do 
severe impressions on the ear ; so, occa- 
sionally, does nausea. 



94 



The reciprocal sympathy between the 
eye and the brain, in too vivid impressions 
on the one, or excited states of the other, 
is famihar. Touch will convey feelings of 
disgust ; even nausea ; or a sense of shud- 
dering, in its origin certainly corporeal. 
We derive some kind of pleasure too, from 
the same source, in the examination of ob- 
jects, which are smooth or symmetrical. 
Smell and taste seem to guard the stomach 
and lungs especially ; and to examine impres- 
sions about to be submitted to these organs. 
Animals neither eat that which the taste 
or smell rejects, nor do they willingly 
breathe an air impregnated with (to them) 
an ungrateful odour. 

A few examples will illustrate the 

Sympathy of the Exteimal Senses zmth each 
other. 

The sense of taste is much affected by 
those of smelhng and sight. Any disor- 
dered impression on the eye, or nose, gene- 
rally affects the power of taste ; and we 
either find the sense diminished, or lose 



95 



altogether the power of distinguisliing fla- 
vour. The fact has been often exemphfied 
artificially, by shutting the eye and closing 
the nostril, when the best judge of wine 
will seldom know the difference between 
port and sherry, or any two of similar strengtli 
with which you may present him. Closing 
the eye only, has some little effect ; as I 
once witnessed in the person of a popular 
comedian. At first, he guessed rightly 
the wine which was handed him ; but, from 
his hesitation, it was evidently a matter of 
difficulty. After the trial had been re- 
peated, he said that he could discriminate 
no longer, that it would be altogether a 
matter of accident ; and so the experiment 
was discontinued. The practice of giving 
sternutatories in affections of the eye, seems 
to have originated in the observation of the 
sympathy between the nose and eye. This 
sympathy, as well as the lachrymation con- 
sequent on stimulants applied to the gus- 
tatory sense, as in mustard or pepper, seems 
more referrible to the functional sympa- 
thies of the mucous surfaces to which they 
are applied, tlian to the sensual properties 



96 



of the respective organs ; yet this does 
not, practically, make much difference ; as 
the surfaces in question, and the senses to 
which they belong, sympathize with each 
other. 

We constantly find touch and vision 
acting together, in examination of surfaces ; 
as if one sense were examining the nature, 
of impressions, conveyed by the other. 
The eye and ear exhibit many sympathetic 
manifestations. 

It is recorded (but where, I now forget), 
that a Wind man, being asked his idea of 
scarlet, said that it was hke the sound of a 
trumpet ; and that a deaf man, being asked 
his idea of a trumpet, said it was like scarlet. 
The force, however, of the coincidence will 
entirely depend on the circumstances ; as 
connected with, or independent of, pre- 
vious association of the sound and colour 
in question. Mr. Maugham, the intelli- 
gent lecturer on chemistry, at that interest- 
ing establishment, the " National Gallery 
of Science," told me, a few days since, that 
he knew a distinguished blind musician, 
who was accustomed to express his idea of 



97 



scarlet by comparing it to the sound of 
a trumpet. 

The increased accuracy of touch, in cer- 
tain cases of blindness, is well known ; as 
is the fact of its becoming, in some in- 
stances, so refined, as to enable the indivi- 
dual to distinguish colours of surfaces by 
this sense alone. This is not only a very 
interesting fact, as regards the power con- 
ferred on the sense of touch, but it appears 
further important, as suggesting the possi- 
bility, that differences of colour, may de- 
pend on some difference of arrangement, in 
the molecules of their respective surfaces : a 
circumstance, as it appears to me, not at all 
inconsistent with the ascertained facts of 
electro-chemical science. 

The connexion of the external senses, is 
sometimes evinced, by the mode which vve 
adopt, when we desire to use any one with 
unusual accuracy. Sometimes we use one 
sense to aid another ; sometimes we endea- 
vour to concentrate our power on that which 
is in operation. We carry this occasion- 
ally so far, as to shut one eye when we wisli- 
tobe absolutely correct, as in taking aim ; or 

H 



98 



in examining minute objects, though this is 
not constant ; some few persons keeping 
both eyes open. An association of this 
kind, exemplified in different modes in dif- 
ferent persons, is observable between the 
eye and the ear. If we wish to hear im- 
pressions of great delicacy ; when, in fact, 
the object is to ascertain whether there be 
any sound at all, we usually close the eye, 
or at least so dispose it, that the sense is 
evidently shut. But if the object be to dis- 
criminate between a multitude of sounds, 
as at a concert to judge of a particular 
instrument, where all are audible, we pur- 
sue a different course. The association of 
the eye with distance appears to render it 
useful in directing the ear to the particular 
spot whence the sound we wish to discri- 
minate proceeds ; for, whether this be or be 
not the reason, we certainly often place the 
eye exactly as when we wish to render its 
inipressions unusually accurate or refined ; 
and either listen with one eye closed, or 
contract the eyebrow as in frowning. Some- 
times we first look towards the spot whence 
the sound proceeds, and then turn our ear 
in that directi()n. 



99 



The reader will perceive how easy it 
would be to amplify on such a subject ; but 
as my only object is to impress the con- 
nexion of all parts with each other, the 
illustrations alluded to will be sufficient ; 
and we may proceed to speak of the sym- 
pathy of the 

1 

External Senses with the Mind, 

The senses of smell, taste, and touch, 
for the most part, may be said, in their sym- 
pathetic manifestations, to affect the body ; 
but it is certainly true, that, by association 
of ideas, they also occasionally affect the 
mind. When impressions are received by 
these senses, to which they have long been 
strangers, we seldom fail to recognize a 
resuscitation of those sensations, whether 
of pain or pleasure, by w^hich they were 
formerly accompanied. The mind is thus 
frequently led to very vivid recollections of 
circumstances, of which it seemed to have 
lost the impression. The preference to 
particular objects of these senses, such as 
certain flowers, or fruits, which have been 
H-2 



100 



connected with our early associations, af- 
fords another illustration of the same thing. 

The eye and the ear differ from the 
senses just referred to, in that, whilst both 
sight and hearing present occasional sympa- 
thetic associations with the body, as those al- 
ready mentioned, besides many which might 
be added, as in affections of the abdominal 
viscera, — yet they manifest these relations 
much more strikingly with the mind. 

The sight of a distressing scene pro- 
duces a sympathy obviously mental : so is 
that felt in the recognition of beauty, either 
in an individual object, or in the grouping 
of a fine prospect. Many impressions on 
the ear produce mental emotion ; as the 
cry of distress, or of bodily suffering. 
Pleasing impressions of a low degree are 
exemplified in the sleep produced by mo- 
derate, continued, and monotonous impres- 
sions on that organ ; this applies to most 
people ; but it is particularly well exem- 
plified in children. 

Few things, indeed, pleasingly affect the 
ear, unless they excite some action which 
is mental. 



101 



Pleasurable sensations, whilst they best 
demonstrate the beneficence of the arrange- 
ment, appear also most happily to illustrate 
the sympathy of these senses with mind 
and body. The gratification derived from 
the contemplation of natural scenery ; that 
sensation of pleasure and peace which it 
diffuses over the stormy elements, which, in 
most minds, are in too active and constant 
operation ; the manner in which these sen- 
sations are heightened or sustained by the 
hum of various insects, in their multiform 
vocations, the song of birds, or by the less 
exciting varieties of human melody or har- 
mony ; the delightful sensations of health, 
purity, and enjoyment, from the breeze 
fraught with the odour of healthy vege- 
tation, or the perfume of flowers, — severally 
illustrate these sympathies. 

Darkness and silence, however, excite 
a mental sympathy, and produce, through 
the imagination, very vivid impressions. 
There is something awful in a forest of a 
dark night ; and the silence of winter, in 
broad day, is often productive of peculiar 
sensations. These may be again heightened 



102 



by reflection ; such as that this sleep of 
nature is only apparent, that the earth is 
still teeming with millions of creative pro- 
cesses, whichj by and by, the sun will burst 
forth into visible existence. That the 
trees, which now appear so shorn and 
wretched, have their circulation still going 
on, that Nature is still active, amidst a si- 
lence, which (though it may be less pleas- 
ing than when she is vocal with animal life, 
and clothed with flowers and verdure) still 
infuses through us a high degree of plea- 
surable feeling, and wraps it in the sublime. 
When we think deeply, solitude and silence, 
if not necessary, at least very much facili- 
tate concentration of intellectual power ; 
and closing the eyes seems to assist the 
power of reflection. Even the pleasures of 
taste, when not fatigued by excess, or per- 
verted by sensuality, impress one's con- 
sciousness with evidence of the sympathy 
of this sense with mind and body. The 
subject might be pursued at almost any 
length ; but the material fact is, that the 
senses have sympathy with the body, with 
the mind, and with each other. From the 



103 



links thus formed, we are naturally led to 
contemplate the sympathy between the 
mind and body. Notwithstanding our pro- 
found ignorance on this subject, we cannot 
but regard it, on reflection, as one of ab- 
sorbing interest ; and I cannot but think, 
that, if, instead of the fruitless labour of 
speculating on their mode of connexion, 
we were to confine our observations to the 
phenomena which this connexion unfolds, 
we should find our labour far from unpro- 
fitable. 

The sympathy of the mind with the 
body, like that between corporeal structures, 
seems limited ; but, by very different, and, 
in some respects, opposite, considerations. 
The sympathies of the body appear to 
evince increased susceptibility under the 
influence of disease, and to be more easily 
excited in states of declining power. The 
reverse of this happens with regard to the 
mind. 

Its sympathy becomes limited by other 
considerations, and frequently in a very 
marked manner. Having suffered for a 
long time in common with the body, the 



104 



mind often seems to recognize its approach- 
ing separation ; and that, as her corporeal 
connexions are about to cease, so her cor- 
poreal functions are no longer required. 
The more animal portion, indeed, seems to 
decline with the body, the passions fade. 
If any thing remain, it is either what ap- 
pears least earthly, as the affections, — or 
most linked with reason, as hope. 

Reason holds little of this sympathy : 
she often evinces her supremacy, in the 
isolation of her proper function ; in exert- 
ing her power with a force, and even with a 
serenity, unusual in health ; and, amidst the 
throes of a perishing body, seems to repu- 
diate her connexion with organized matter ; 
suggesting what Cicero so finely expresses, 
— " Est enim animus coelestis exaltissimo 
domicilio depressus, et quasi demersus in 
terram, locum, divinae naturae eeternitatique, 
contrarium." 

Without entering into any metaphysical 
argument, it is easy to recognize, in the 
mind, two orders of functions. The one, 
that assemblage of faculties which we call 
Reason ; the other, that association of feel- 



105 



ings and propensities constituting the Pas- 
sions. The former may be regarded as the 
distinguishing attribiite of our species ; the 
latter we enjoy in common with other 
animals. Love, joy, grief, anger, are the 
common possessions of both ; reflection, 
com})arison, the resultant of these, judg- 
ment, appear to be peculiar to man. 

Like every thing else in nature, the 
transition from one being, to another class 
or mode of existence, appears gradual. To 
say where Reason begins and Instinct ends, 
is not merely difficult, but obviously im- 
possible. The broader distinctions between 
them are nevertheless sufficiently apparent. 

In the moral constitution of man, in 
the extended sense of the term. Reason 
and the Passions are, in some sort anta- 
gonist powers, without that happy adjust- 
ment of equilibrium, of which we recognize 
a physical type in some corporeal struc- 
tures. On the contrary, these principles, 
call them what you will, are generally in a 
state of warfare, seldom ended but by the 
death or decline of one of the bellioerents, 
and often not until that of the individual in 



106 



whom they operate. Sometimes, indeed, 
they act in concert — a rare moment of 
moral excellence. The former is the rule ; 
the concurrent action the exception. But 
if it be true that we find individual exist- 
ences constantly shaded off into each other, 
it would seem that reason and the passions, 
principles so different, should not be, as it 
were, abruptly conjoined. There appear to 
me to exist, properties which belong exclu - 
sively to neither, yet are allied to both ; and 
that hope, " the sick man's friend," is at 
least one of these. As a feeling to which we 
cling with an instinctive tenacity, and which 
acts under the most depressing influences, 
without our seeing or thinking of the 
grounds on which it does so, it seems allied 
to the passions : as a principle which carries 
our views into futurity, and leads to an ex- 
amination of the grounds on which they are 
based, it seems distinctly connected with 
reason. Despair seems little else than the 
absence of hope, expectation little more 
than hope, examined and approved by 
Reason. Now, that reason and the passions 
sympathize with each other, could be 



107 



easily exemplified ; but our present object 
is more closely followed, in enquiring how 
they sympathize with the body ; and by ex- 
amining whether (although they both sym- 
pathize with the whole body) there may not 
be certain organs with which this sympathy 
is usually more strikingly exemplified. 

Now, although both reason and the pas- 
sions are capable of affecting the whole 
system, it seems very evident that they 
have partialities in their sympathies. The 
passions sympathize chiefly with the heart, 
lungs, diaphragm, liver, and, perhaps, kid- 
ney ; all of them organs presenting no ma- 
terial difference in man and other animals ; 
all, either entu'ely independent of volition, 
or having, as in the case of the diaphragm, 
the same modified connexion with it, in 
both cases. The heart is especially affected 
by the passions — by joy, grief, and anger, 
for example ; so are the diaphragm and 
lungs ; so is the liver by melancholy im- 
impressions ; and the kidney and bladder, 
occasionally^ by sudden impressions of any 
kind*. The alimentary canal is also affected 

* To these of course miglit be added the generative organs. 



108 



by the passions; and its upper portion, per- 
haps, more particularly, but in a different 
way ; neither so frequently, so strikingly in 
degree, nor so directly in manner. Many 
of the passions are in daily operation, with- 
out producing any effect on the stomach ; 
and even when the passions do affect the 
stomach in the marked way which is some- 
times observable, they seldom do it other- 
wise than intermediately, through some other 
organ, as the heart or nervous system ; as 
in grief, or excessive joy. Sometimes boys, 
when about to leave school, can eat very 
little on the last day, for joy ; but the 
whole system is in a state of excitement. 
An opposite state, attended with the same 
deficiency of appetite, occurs in intense 
grief ; the stomach is affected, but the 
whole system is depressed. In fact, so mo- 
dified is the sympathy of the stomach with 
the passions, that they seldom appear to 
affect it, unless the excitement be excessive, 
or their operation very suddenly developed, 
which, producing either a disturbed state 
of the circulation, or of the nervous system, 
or both, does not affect the argument. 



109 



Whilst the sympathy, then, of the pas- 
sions with the stomach is sometimes modi- 
fied in degree, or intermediate in manner, 
Reason seems to have a more particular 
sympathy with that organ than any other, 
the brain only excepted. The stomach is 
considerably, and in a very important sense, 
under the influence of the will. Those 
organs more immediately connected with 
the passions, are out of its dominion. The 
consideration of the stomach in man, sug- 
gests many peculiarities in his physical 
composition, scarcely less striking than 
those which reason affords with regard to 
his moral constitution. Man can digest 
almost every kind of food, and this not in 
the zi)ay of an exception*^ nor merely in ex- 
ertion of that wonderful pouter of accommo- 
dation with which animals are endowed^ hut 
from a p Oliver or fimction zchich^ an examin- 
ation of the whole of the digestive apparatus^ 
seems to demonstrate as ordinary and ori- 
ginal. Even this capacity, so viewed, is a 
rare circumstance : I am not prepared to 
say that it is unique. 

I know of no animal where the anato- 



110 



mical characters so strikingly demonstrate 
the omnivorous habit of the individual, nor 
in whom the teeth so exactly combine the 
powers necessary to the division of both 
kinds of ahment. 

Other animals, which are omnivorous, 
so far as I know, always evince predilections 
for one class of food ; which we do not 
observe in man. This might be variously 
exemplified; but we can scarcely select a 
more omnivorous animal than a pig, yet he 
evinces very decided predilections. 

But if these views be questioned, there 
is still a much more interesting peculiarity 
to be noticed. Although the human sto- 
mach has the power of assimilating various 
kinds of food, it can digest comparatively 
but few, without previous preparation ; it 
shrinks from the attempt, and this at once 
brino:s the functions of the stomach in con- 
nexion with reason. The manners of the 
most primitive people do not contradict 
this fact ; the culinary art of civilized life 
afford a curious exemplification of it. Fur- 
ther, the excitement of appetite by every 
sustained operation of the reasoning faculty. 



Ill 



— the proportion observable in their in- 
tensities, where the extreme of exertion is 
avoided ; — the thin, spare bodies, even to 
leanness, of many whose intellectual la- 
bours are great, but who take a great deal 
of food with little or no exercise, and in 
whom, even for years, no failure of assimi- 
lating power is observable ; — the instinctive 
feeling of vigour, the clear perception, the 
facility in the arrangement of ideas, ac- 
cording to the povv^ers of the individual, 
which accompany moderate exertion, or 
otherwise induced tranquil conditions of 
the stomach; compared with, the inaptitude 
for exertion, the confusion of ideas — in a 
word, the intellectual inefficiency so fre- 
quently resulting from a loaded, fatigued, 
irritated, or otherwise disordered condition 
of the organ, — are so many circumstances 
which seem to demonstrate a striking sym- 
pathy between the stomach and the rational 
faculty; and not discernably, in the majority 
of cases, by other than a direct agency. 
Horace, who was an acute observer, after 
saying hovv^ pale people sometimes rise 
from the loaded table, 



112 



" Vides, lit pallidus omnis, 

Ceena desiirgat dubia ?" 

proceeds to remark how the mind, also, 
subsequently becomes affected — 

quill corpus oiiustum, 

Hesternis vitiis animum quoque prcrgravat una, 
' Atque adfigit humo, divinse particulam aurep. 

For my part, I cannot help thinking 
that some light is thrown on the subject by 
the moral argument ; I feel a difficulty in 
con cei vino; that an orran so much connected 
with the practice of self-denial, one of the 
highest faculties of our reason, has this con- 
nexion without some object. I mention 
this point, not as merely arising naturally 
from pursuing the consideration of the con- 
nexion of different principles, or existences 
with each other ; but as tending to enforce 
the scientific or professional part of the ar- 
gument ; for when we observe corporeal 
functions thus associated with our highest 
mental faculties, how can we suppose that, 
under any circumstances, these corporeal 
functions should become insulated from 
each other. 



113 



When self-denial is altogetlier laid aside, 
with regard to the stomach, the present 
gratification, as contrasted with the future 
inconvenience or suffering, is, to my mind, 
very typical of what happens with regard 
to its exercise or abandonment in higher 
matters ; whilst the small degree of self- 
denial required, when it is habitually exer- 
cised, as contrasted with that, rendered in 
time necessary by indulgence, is precisely 
what happens with regard to the govern- 
ment, or rather misgovernment, of more 
serious propensities. 

Again ; so far as we are capable of 
judging, mere animal purposes, either as 
regards the personal safety of the indivi- 
dual, or that beneficence which converts 
even our wants into sources of gratification, 
might have been answered by small modi- 
fications of the external senses. A very little 
observation of the qeconomy or habits of 
animals, strikingly exemplifies this remark ; 
but in the connexion which we trace be- 
tween reason and the stomach, that organ 
in man, appears linked with his moral con- 
stitution. 

I 



114 



How else the health, the comfort, the 
intellectual efficiency, in short, the virtue 
of temperance- — how else the disturbed 
nerve, the vacillating decrepitude, the mi- 
serable wreck of intellectual power, the 
blasted moral perception, in fact, the vice, 
of intemperance ? 

There is nothing approaching this in 
animals left to their instincts. For what 
purpose, then, the arrangement which 
permits it in man? — If not moral, what 
is it?- — If moral, why then rational, and 
the stomach one of the organs in con- 
nexion with its manifestation. It is not 
possible for me to pursue this subject 
in the prosecution of a design, wherein I 
am obliged to touch on points, many of 
which, if fully discussed, would singly 
occupy a small volume. My object has 
been to arrange some of the more impor- 
tant sympathies, so as to facilitate, if it do 
not invite your deeper consideration of 
them ; and to impress on you, by means of 
the evidence thus supplied, that linking 
together of various functions into one har- 
monious whole, in which we perceive even 



115 



our highest faculties and feelings, brought 
into connexion with our physical nature. 
I hope thus to excite a closer observation 
of the phenomena of sympathy, by which 
alone we can expect to discover the laws 
of its operation. In all sciences, the most 
wonderful progress has been made by such 
enquiries ; but whether we regard solid 
bodies or fluids, substances tangible or in- 
tangible, aeriform or gaseous ; whether we 
consider matter in the ao^o:reo;ate, or in the 
most minute analysis at which we can ar- 
rive ; whether we consider the subjects of 
chemistry, heat, light, electricity, in their 
intensely interesting relations to each other; 
whether we consider their operation on this 
globe, or the influence exerted by them, or 
similar principles, on those countless sys- 
tems around us ; whether we regard the as- 
tonishing progress which the human mind 
has made in the discovery of attraction, gravi- 
tation, and those laws which unfold so much 
of the physical relations of the heavenly 
bodies ; whether, when visible, or when, as in 
the case of comets, immersed in the incon- 
ceivable depths of infinite space ; I say, 
1 2 



116 



whether we consider one or all of these things, 
or many others, suggested by an examination 
of any of the sciences, — we shall find that our 
information has been generally derived from 
the study of obvious phenomena ; that our 
knowledge of final, or, to speak more cor- 
rectly, secondary causes, consists in the as- 
certainment of our profound ignorance : 
apparently an intellectual paradox, but 
strictly and literally true ; the knowledge of 
the extent of our io;norance is wrought out 
of the depths of human wisdom. 

So with sympathy ; we cannot hope to 
arrive at a knowledge of its intrinsic nature ; 
but some of its more important laws, its 
usual channels of operation, even the indi- 
cations of its salutary or destructive ten- 
dency, may probably be discovered ; and 
on so being, unfold to us new modes of 
enlarging and improving medical science, 
which, in the elevating nature of its various 
studies, yields to no branch of human 
knowledge ; whilst in its utility, if mea- 
sured by its influence in relieving the 
worst of temporal afflictions, it is superior 
to every other. 



117 



I sliall now endeavour to sliew some of 
the important bearings which the sympa- 
thies maintain in the causation of diseases, 
and in guiding us to their successful ma- 
nagement ; and how, whilst they admit and 
explain the local, they enlarge the influence 
and demonstrate the superior importance, of 
what has been termed (and which, in the 
absence of a better phrase, may still be called) 
the constitutional treatment of them. How, 
in fact, by explaining the access of dis- 
ease, they expand our powers of preventing 
or relieving it, and enforce the precept 



Sperate Miseri, Cavete Felices. 



CHAPTER VL 



SYMPATHY CONSIDERED IN ITS 
APPLICATION TO TPIE HISTORY 
AND TREATMENT OF DISEASE. 

However interesting the sympathies of 
the body may be to the natural Theologian, 
as swelling the tide of evidence, every where 
afforded, of design and beneficence — how- 
ever pleasing to the Philosopher, as unfold- 
ing another example of the beautiful har- 
mony of nature — however they may induce 
the Anatomist to pause during his investiga- 
tion of mechanical relations, to contemplate 
the machinery through which the compli- 
cated phenomena of the sympathies are 
developed ; or the Physiologist, whilst he 
endeavours to add to whatever knowledge 



119 



he may have of any one function, some no- 
tion of its connexion with any other — still 
the object of the Surgeon is to examine if 
they throw any light on the treatment of 
disease. 

However complicated those considera- 
tions, included in the survey which he takes 
of the bearings of the sympathies on each 
other; his ultimate object is single, to dis- 
cover their influence in disease. 

Discarding any attempt to theorize on 
the precise nature of the sympathies, not so 
much because it is less interesting, as be- 
cause it is less useful, he keeps a vigilant 
eye on the phenomena they disclose, and 
knowing that, however far his science may 
be from perfection, its progress will be in 
exact proportion to his perception of the 
laws of nature ; he endeavours to discover, 
through the sympathies, what the intentions 
of nature in diseases may be, and the mode 
by which she endeavours to fulfil them. If 
the study serve him not in this object, al- 
though a delightful pastime, he scarcely 
considers it any longer a legitimate object 
of pursuit ; he rather reverts to those claims 



120 



on his attention which many other parts of 
science suggest to him, and which he knows 
the longest life is seldom sufficient to answer. 

Now, it appears to me that a little re- 
flexion will convince any one that the study 
of the sympathies of the body, instead of 
being barren of that interest which utility 
confers, is abundantly prolific, in the prac- 
tical information it brings ; it appears to 
establish many important facts ; to assist us 
in understanding the causation of diseases ; 
to improve our mode of attacking those 
over which we have already some control ; 
and to enable us to cope with others which, 
without such assistance, defy our power. 

Whether the reader may be induced to 
think thus, I know not, but I shall be per- 
fectly satisfied if he will only give the sub- 
ject a patient consideration. 

The consider atio7i of Sympathy establishes 
many facts. 

I will briefly dismiss this point, by refer- 
ring merely to the evidence already adduced, 
which is only a very small paji of what might 



have been brought forward, to ilhistrate that 
general consent of action in the whole body, 
wliich proves its unity ; and the bearing 
which this necessarily must have on the 
constitutional, as opposed to the local, treat- 
ment of disease. 

The study of Sympathy assists us in under- 
standing the Causation of Diseases, 

We should first consider how diseases 
happen ; and as those to which I shall refer 
are the most prevailing, as well as the most 
dangerous, diseases of the climate in which 
we live, I trust, if the argument prove a little 
lengthy, the importance of the subject will 
procure me that indulgence which my im- 
perfect mode of treating it might justly deny. 

I suppose we shall not differ as to the 
following facts : — First, that the most im- 
portant diseases of this country are scro- 
phula, in its various forms (including 
phthisis), gout, rheumatism, inflammatory 
affections generally, and fevers of various 
type and severity. Secondly, that the opc- 
ration of exciting causes is often as \ isible 
as their natwre is beyond our perception. 



122 



Thirdly, that the exciting causes, generally 
consist of certain impressions, applied 
directly to the nervous system, or to the 
digestive organs; or to the skin, or the lungs, 
as happens with regard to atmospheric 
agencies. Fourthly, that disturbance of 
these parts (nervous system, digestive organs, 
skin, and lungs) generally takes place simul- 
taneously; or, that to whichever one of them 
the injurious influence may have been first 
addressed, that some one of the others, and 
commonly all, very speedily manifest a 
greater or less participation in the dis- 
turbance. 

I wish you to recollect, at the same time, 
that, in comparatively healthy states of body, 
the sympathies have a salutary tendency, 
and for the most part a salutary effect; such 
as the relief of disturbed bowels, by mode- 
rate spontaneous discharges of the offending 
matter, or by increase of secretion ; or, in that 
increased secretion, which takes place from 
surfaces, under irritation by fever, cold, or 
otherwise; that in disordered conditions of 
the system the case is widely different ; that 
in this case, the sympathies not only often 



1-23 



render occurrences (a catarrh, for example), 
ordinarily trivial, of a very important 
character ; as in the sympathy of the bron- 
chial ramifications with the skin ; bnt that 
where there is pre-existing disease, say 
tuberculated lung, they will also frequently 
convert them into fatal maladies, as is shewn 
in the history of many cases of phthisis 
pulmonalis. Again, the sick head-ache which 
suspends the action of the stomach, through 
which the injurious impression has been re- 
ceived, is a salutary sympathy. Apoplexy 
and paralysis are often but diseased exem- 
plifications of a similar connexion. 

Thus far, I apprehend, I have stated no 
fact which is otherwise than well known. 

Let us now proceed to consider the 
effects of a common cold. A man gets wet 
in his feet; or a blast of air blowing on a 
certain district of the skin shall have pro- 
duced rigidity of the muscles beneath it, or 
in the vicinity ; he is perhaps affected with 
sore throat, irritation, and dryness of the 
mouth and fauces; he goes to bed, takes 
some warm gruel, puts his feet in warm 
water, and gets well — or, taking no precau- 



124 



tion of this kind, or, those he does adopt 
not proving beneficial, he has cough; this 
continuing, he seeks advice, and is reheved : 
but he is not well ; on the contrary, he con- 
tinues ailing, his countenance shrinks, his 
distended nostrils, his emaciation, his fre- 
quent pulse, his expectoration, his profuse 
perspirations, announce serious indisposi- 
tion; he becomes perhaps purged,hectic; he 
dies, in fact, of phthisis. Or this " catching 
of cold," which I have mentioned, is fol- 
lowed by a rigor, pain, sickness, constipa- 
tion, inflammation of the bowels or perito- 
naeum ; the most active measures are 
employed, as bleeding, blistering, calomel 
and opium, enemata, warm bath, and so on ; 
he is relieved ; or, not being so, in forty-eight 
hours he may be a corpse ; or, the cold may 
be followed, in another, by an ill-defined 
restlessness, and fidgetty condition ; and he 
wakes, perhaps, in the morning, with a fit of 
gout — or, sometimes without, but more 
generally with some premonitory symptoms; 
he is laid up with acute rheumatism: — but 
here we are supposing that the exciting 
cause has been applied to the skin. 



125 



Now, the exciting cause may be applied 
to the stomach or hings, or nervous system, 
and yet the phenomena may be identical. 

The exciting causes may be, repletion 
in the lungs, as in some cases of phthisis; 
or disorder of the stomach, from the un- 
wholesome quality, or excessive quantity of 
food ; or depressing influences applied to 
the nervous system : yet, as I have said, the 
phenomena shall not be distinguishably 
different from those where the exciting 
cause had been applied to the skin. 

We frequently hear people complain 
that they have caught cold, and they know 
not how; and that, in many of such cases, 
the disordering impression has, neverthe- 
less, been derived from changes of tempera- 
ture, acting primarily on the skin, cannot 
be doubted; since the climate in which we 
live, the large surface, and constant ex- 
posure, as well as the important connexions 
of this organ, render it much more under 
the influence of external impressions, than 
any other. The same remark applies, with 
some modification, to the lungs also. 

Many circumstances, however, tend to 



126 



shew, that the disordering agency of cold, 
owes its impression, in many cases, to a pre- 
vious morbid excitabihty of skin, derived 
from other sources — a question which we will 
examine as we proceed. In the mean time, 
it may be observed, that the phenomena of 
cold are not always produced by going from 
warm to a cold temperature, as is generally 
supposed. Sometimes passing from ordinary 
to high temperatures will give rise to the 
same phenomena. 

I recollect a very marked case of catar- 
rhal ophthalmia, so produced. It is difficult, 
in a chmate like this, to trace a cold as a 
primary consequence of nervous depres- 
sion; though it is common enough, as giving 
rise to the excitability to cold and other dis- 
orders. The most direct impression which 
it produces in common with cold, without 
its agency, is seen in some cases of gout 
and rheumatism. Disorder of the stomach, 
however, will very frequently produce " a 
cold" in all its varieties; and I knew a 
gentleman, who was so well aware of this, 
as regarded his own person, that when he 
has incautiously eaten any thing, which 



127 



former experience liad shewn him to be 
unsafe, he lias frequently predicted, that 
he should have a cold in the course of the 
evening. In his case, it appeared in the 
form of what is called a cold in the head : 
viz. sensations of fulness, heaviness, heat and 
dryness about the nose and fauces, and sub- 
sequent augmentation of secretion. 

Now I wish you to consider how all this 
happens, if it be not by sympathy between 
the respective parts. But if the resuks of 
a given excitement be so different as those 
which I have described ; I mean not as to 
their kind so much as to their degree; hov/ 
does it happen ? For, although the idio- 
syncrasy of different individuals would ex- 
plain some cases, yet the different results, 
which I have mentioned, may have occurred 
in the same individual; wherefore, supposing 
the exciting causes to be alike, the different 
effects must result from the varying condi- 
tion of such individual. 

This, then, is the next point for examina- 
tion ; for it is certain that the air to which 
we are exposed, or which we breathe with 
impunity, at one period, will often give us 



128 



cold at another; that a viand eaten without 
producing disorder in the digestive organs 
at one period, may excite very marked dis- 
turbance at another; and that impressions 
on the nervous system, over which we ride 
buoyant as it were to day, may depress us 
exceedingly, if we are exposed to them, to 
morrow. 

Mr. A ber net hy used to say, that a very 
useful book, he conceived, might be written 
on " catching cold." He did not explain 
himself; but I have no doubt he alluded to 
the complicated effects, produced in some 
such cases through the influences, either 
separately or in conjunction, of the sympa- 
thies on a previously disordered condition 
of the nervous system; whether induced 
by disorder of the digestive organs, or 
otherwise ; for my part, I think, modified in 
its effects by such circumstances, cold, or, to 
speak more correctly, change of tempera- 
ture, acting through the sympathetic in- 
fluence of the skin, seems the exciting 
cause of the principal diseases of this 
country. 

Let us then consider a little further the 



129 



different effects of the same agents, " cold 
and moisture," when applied to the skin. 

^Vhenever cold and moisture are applied 
to the skin with perfect impmiity,as regards 
the health, I believe it will be found, that 
reaction is produced in the part ; which, in- 
creasing its actions in proportion to the de- 
pressing influences to which it is subjected, 
preserves the equilibrium of the circulation, 
and prevents that determination of the 
blood to other parts, which is the beginning 
of disease, whether this be manifested in 
the part to which the blood is so determined, 
or otherwise : and further, that this reaction 
is equally invariable, whether the whole, or 
only a part, of the skin has been affected. 

The reaction of the skin, after bathing, 
is familiar; it is perhaps even more marked 
in the glow, often consequent on changing 
our clothes, after having been, as it is 
termed, wet through. The state of skin it 
implies, is more visibly demonstrated, by the 
increased vascularity of the hands of boys 
who are fond of dabbling in the water, and 
in the ruddy limbs of those who have these 
parts habitually exposed. 

K 



13Q 



If the skin, from any cause, be not 
vigorous, — or say, if you please, that the cold 
be long continued, — the reaction does not 
then take place, or after a time ceases ; there 
is then a sensation of chilliness. If this 
chilliness be allowed to continue, the re- 
action, which ordinarily takes place in the 
skin, is succeeded by one analogous, in some 
other part ; and, in the great majority of 
cases, in some one with which the skin is 
known to sympathize. Now, that this is 
sympathy, the remedies which are successful, 
as well as the history of disease, alike de- 
monstrate. 

Say that the primary aftection of the 
skin produces an affection of the throat — 
what is it, but an increased vascular action, 
analogous to that which should have taken 
place on the skin ? The patient applies a 
warm stocking to the throat, gets into a 
warm bed, and often rises in the morning 
nearly or quite well. 

Now, here the remedy, as well as the 
exciter of the disease, is applied to the skin ; 
but you may equally remove the disorder, 
in many cases, by remedies applied to the 



131 



throat; or, more commonly still, to other 
organs : but it is of consequence to observe, 
that you cannot effect this, without pro- 
ducing in the skin (in which there may, 
perhaps, be now no very marked feelings of 
disturbance) actions opposed to those which 
first characterized the disorder ; actions 
evidencing a return of the circulation to its 
equilibrium. This remark is equally true, 
whether we apply it to remedies adminis- 
tered to the stomach, bowels, or skin; or 
even to the popular remedy for a cold and 
sore throat, brandy and sugar, which, where- 
ever it does good, produces diaphoresis ; but 
should the part which sympathizes with the 
skin be previously disordered, the sympa- 
thetic excitement is much more serious ; if 
the part thus sympathetically attacked be 
previously diseased, or, should the general 
health have been previously disturbed, the 
consequences are frequently fatal. 

Persons having a disposition to bron- 
chitis, illustrate the former position; chronic 
disease of the larynx, or tuberculated lung, 
the latter. If the liver have been previously 
disordered, a general state of excitement is 

K 2 



132 



set up, popularly called a bilious attack ; if 
this be exaggerated, you have fever, of the 
continued or remittent kind. If the liver 
be diseased, you may have irritative fever, 
exhaustion, shivering, and suppuration : in 
fact, you have sometimes a slight disturb- 
ance, of some part, which is readily re- 
moved ; sometimes you have serious indis- 
position; sometimes a fatal malady; and all, 
where the exciting cause is not distinguish- 
ably different. It frequently happens, that 
these different results have taken place in 
the same individual. How are we to ex- 
plain the difference ? It would be presump- 
tuous, perhaps, to answer this question very 
positively ; but I will tell you what my im- 
pressions on the subject are, and the reason- 
ing on whicli they are based. Now, it is 
clear that the different effects produced by 
external influences, which appear in their 
nature identical, must owe their primary 
character to the state of the nervous system 
to which they are presented. And this, be- 
cause we can conceive no other source 
through which they make any impression at 
all. To say what this particular state of the 



133 



nervous system may be, as appearing ir- 
ritable, excitable, or what not, is unneces- 
sary ; it encumbers the argument, without 
assisting the investigation. 

Different conditions of the nervous 
system, then, occasion very different effects, 
to be produced from external causes, which 
we believe to be identical. 

Now, then, what is it which produces 
these or any differences in the nervous 
system ? That seems to be the first step in 
the enquiry. 

There may be, and probably are, many 
causes, with which we are unacquainted ; but 
there are many others which are well known, 
as disturbers of the nervous system. Dis- 
order of any one function of the body, is 
competent to produce general disturbance of 
the nervous system. But disorders of some 
parts, or impressions of a particular kind, 
produce a greater or more marked disturb- 
ance than others ; for example, disorders of 
the stomach, or painful mental impressions. 
Here, then, we have again a wide field opened 
for enquiry ; for if it indeed be true, that 
any organ in the body is competent to dis- 



134 



order the nervous system, and that some 
derange it more than others, it is evident 
that the next step will be to enquire which 
organ, by the frequency of its disorders, 
by the importance of its connexions, or by 
its power of disturbing the nervous system, 
is hkely to be the most frequent cause of 
disturbance ; and then to see how this ac- 
cords with, or explains, any other facts, 
afforded by experience or observation. But^ 
previously to making this enquiry, there are 
some preliminary observations to be sub- 
mitted to you. 

Now, when cold is applied to the skin, 
and reaction does not take place, it de- 
presses the circulation of the part; and this 
effect, propagated over the surface by sym- 
pathy, produces a general depression; a sense 
of shivering supervenes. This effect can- 
not be accompanied by any diminution of 
the circulating blood ; and hence it follows, 
that there is an unusual determination of 
that fluid to some other part. This will be 
some organ or structure with which the skin 
has a disposition to sympathize ; but the 
particular part will be determined by cir- 



135 



ciimstances ; and these, as has ah'eady been 
observed, will be different at different times, 
even in the same persons. 

The circumstances determining which 
part is to sympathize with the skin, when 
depressed by cold, may, many of them, be 
beyond our research ; those which act most 
commonly, and which appear most import- 
ant, are, I think, very observable. 

First, caeteris paribus (and particularly 
idiosyncrasy excepted), the skin will excite 
sympathies in some part with which it has 
a known tendency so to do ; such as the 
throat, alimentary canal, lungs or kidney, 
&c. 

All other things, too, being alike, it will 
excite sympathy, most frequently, in the 
surface nearest in continuity to it, that is ac- 
accessible by the same influences, — viz. cold 
and moisture. 

Every one knows that a very common 
effect of cold is affection of the nose, throat, 
and fauces. 

But a vast number of cases are not to be 
viewed in this way. The different organs 
are not placed under the same circum- 



136 



stances; and this suggests further modifying 
influences of a more complex character. 

The disposition of any part or organ to 
sympathize with the skin, will be particu- 
larly modified by the condition of that part 
or organ. If this disposition be that of 
disease, its disposition to sympathize will 
be much increased : this is what is called 
a cold flying to the weak part. 

To put this in another way. Suppose 
that, under circumstances of health, the 
respiratory organs have a more excitable 
sympathy with the skin, when impressed by 
cold, than the bowel s. stomach, or liver. 
A very little, of even functional disorder, 
will reverse this order, and make the bowels, 
stomach, liver, or kidney, exhibit a much 
more lively sympathy than the lungs. Or, 
say that the lungs are disordered or dis- 
eased; their sympathy becomes immediately 
more readily excited, and more serious in 
its operation. 

Further, the disorder of a particular 
organ will not only render its sympathies 
more easily excited by depression of the 
cutaneous circulation, but it will quicken the 



137 



sympathies of other organs with which the 
sympathies may be mutual : as the liver, if 
disordered, will first sympathize itself, and 
then induce affection of the stomach and 
head ; and this sometimes so quickly, that 
it appears like a direct sympathy ; the 
previous affection of the liver escaping no- 
tice, in the rapid development of the affec- 
tion of the stomach and head. 

Again, the existence of disorder of any 
organ, prone to sympathize with the skin, 
will not only induce it to take the lead in 
sympathy with the skin, but it will also 
confer on the skin an increased susceptibi- 
lity to primary impressions. The brain, 
stomach, liver, lungs, kidney, and urinary 
organs, all shew this. Were I to select two 
from amongst these, which all so strikingly 
demonstrate the fact, I would choose the 
stomach and kidney. Not only will dis- 
order of the stomach influence the suscep- 
tibility of the skin, but even its condition 
of moderate fulness or emptiness will suf- 
fice. Let any one think of the difference 
of a frosty day, when his stomach is empty, 



138 



or after a meal. Darkness and light are 
not more different than his sensations. 
Every one knows the effect of a strong 
stimukis on the stomach previous to ex- 
posure. 

The phenomena of vomiting have been 
already alhided to. 

In advanced stages of disease of the 
urinary organs, the susceptibihty of the 
skin is exceedingly marked, and nothing is 
more important than to guard it ; nothing 
more quickly exciting the last paroxysm in 
the scene of suffering from urinary diseases 
than some unlucky impression made on the 
sensitive cutaneous surface. It is important, 
here, to remark, that no part has such im- 
portant sympathies as the skin, unless it be 
parts which, like it, contribute to form what 
I have ventured to call the portals of the 
body ; for the nervous system, lungs, di- 
gestive and urinary organs, seem entitled 
to be thus considered. 

Let either of these parts be primarily 
affected, and some other of them, com- 
monly all, in a greater or less degree, 



139 



quickly evince a sympathetic recognition of 
the disturbance. If the stomach, there is 
paleness, chilliness, alternating with heat 
and perspiration, oppressed breathing, and 
depression of nervous energy. If skin, 
either in a severe cold or destructive burn, 
you have similar phenomena. If lungs, the 
skin especially, generally the stomach, and 
always the nervous system ; sometimes by 
depression ; at others, by the buoyancy of 
morbid excitement. 

I need scarcely mention the pale face, 
the deficient appetite, the slow respiration? 
as some of the multiform effects of severe 
primary nervous depression 5 nor need I 
pursue the illustration as regards the urinary 
organs and bowels. 

It is not meant, of course, to be repre- 
sented that these are the constant effects of 
injurious impressions primarily addressed to 
the respective organs ; but they are selected 
as examples, which appear striking, and 
which happen sufficiently often to be fa- 
miliar. 

To recapitulate : it has already been 



140 



stated, that, caeteris paribus, with organs dis- 
posed to sympathize with each other, this 
sympathy will have its activity increased by 
disorder of any one of them, and that its 
effect will be modified by the kind, perhaps 
I should say degree, of that disorder. 

In this view, any disorder in the organs 
I have mentioned, would increase the sus- 
ceptibility of the skin ; would, in fact, 
lessen its vital energies in resisting or coun- 
teracting the effects of cold, doubtless. I 
am aware that two propositions are in- 
volved in the foregoing remark, which are 
not perhaps necessarily co-existent — viz. in- 
crease of susceptibility, with diminution of 
vital energy. As, however, this combined 
effect on the skin, from disorder or disease 
of any important organ, is a well-established 
fact, I do not stop to discuss the question, 
whether increased susceptibility and dimi- 
nished vital power are, or are not, generally^ 
presented in combination ; although the 
general decision of that question does not 
appear to furnish much ground for dif- 
ference of opinion. The next step in the 



141 



enquiry would be, to ascertain what organ, 
by its previous disorder, most frequently 
confers this susceptibihty. 

It must be admitted that there are per- 
sons of dehcate frame, whose nervous sys- 
tems are very susceptible, and who, without 
being in a state justifying the term disease, 
are more prone to suffer from changes of 
temperature than others. 

2ndly. That many, in whom the seat or 
causes of susceptibility can be ascertained, 
are found to have it in the lungs. 

3dly. That the skin, from original pe- 
culiarity, has a varying susceptibility of its 
own : and, 

4thly. That the digestive organs, when 
disordered, are capable of conferring a ge- 
neral susceptibility, and of the skin espe- 
cially, will not, I suppose, be questioned. 

Now, then, we enquire what are the 
most common causes which prevent the 
skin from reacting, as it does in health, 
when depressed by cold, and, instead of 
this (I will not say giving rise to) but being 
followed by fevers, inflammations, affections 
of the lungs or liver, gout, rheumatism, in 



142 



fact, many other disorders ? The argument 
is not very lengthy, but important. Part of 
it is a kind of argument a priori, and we 
will discuss that in the first place. 

In contemplating the primitive state of 
man, every consideration suggests the pro- 
bability of his diseases having been, origi- 
nally, comparatively few and simple ; while 
accidents would have been at times, of 
course, unavoidable ; indeed, it is on this 
ground, that surgery has been supposed to 
be of greater antiquity than medicine. 

The progress of civilization, in the im- 
provement of the medical art, seems also 
to have increased its necessity ; or perhaps 
the converse of this statement would be 
nearer the truth. But still, man would 
have been subject, in all times, to changes 
of temperature, to the influence of the 
passions, and to varying conditions of the 
digestive organs, consequent on that irre- 
gularity, both as to quantity and quality 
of his food, which hunting would more 
generally have supplied. Diseases among 
animals are few, except when they become 
domesticated. This strengthens the sup- 



143 



position, that, in a state of nature, the pre- 
servative powers of the body are sufficient 
to maintain a much nearer approximation 
to health, either in the prevention or re- 
moval of disease, than they are found 
practically to do in civilized communities. 
Hence, in investigating the causes of dis- 
ease, either as occurrino; throuMi the skin 
or any other of the organs, I have men- 
tioned, either from primary impressions, in 
the abstract, or from a force beino; mven to 
them by sympathy, it is desirable that we 
consider what alterations are most likely to 
have been effected by the progress of civi- 
lization and refinement, and through what 
set of organs these changes may have 
chiefly operated. 

Nervous system. The disturbing in- 
fluences applied directly to the nervous 
system (and here I allude to those of a 
moral kind), in a primitive state of man, 
must certainly have been few, in comparison 
to those occurring in a civilized condition. 

In the former case, the passions (fear 
and anger especially, perhaps) would have 
been those most frequent in operation ; 



144 



and, though both tending to impair phy- 
sical power, yet seldom being very en- 
during in their active sense, would not have 
been abundant sources of disease. 

The depressing and exciting influences 
of civilized life, are much more numerous 
and complicated, and impressed on a sensi- 
bility of nervous system much more re- 
fined. Improved moral government would 
doubtless diminish the force of these im- 
pressions ; but they undoubtedly constitute 
predisposing causes to diseases, and, in many 
instances, to those maladies which, in this 
country, are so commonly ushered in by 
what is called "catching cold." 

Yet, on consideration, this predisposing 
influence would appear to be very measured, 
as compared to some others; for "colds" are 
very common, without the concurrence of 
any moral or nervous depression, or excite- 
ment; and nervous disturbance of the moral 
kind is frequent enough, without the occur- 
rence of catarrh of any kind. 

With regard to the changes which 
civilized life may have produced in the im- 
pressions, primarily presented to the lungs 



145 



or skin, we must believe that they have 
been rather in favour of these organs than 
otherwise; if we except the influence of air 
in very crowded cities. Tt is not to be 
denied that the removal or thinning of 
forests, the draining of marshes, and ge- 
neral cultivation of the surface of the earth, 
very much improves the salubrity of the 
atmosphere. This is a matter susceptible of 
demonstration. Then, as regards changes of 
temperature, which are unavoidable, the pro- 
gress of civilization would have improved 
our methods of defence in the more effi- 
cient adaptation of clothing to the circum- 
stances, and which the progress of the arts 
and manufactures would obviously supply. 
Some drawback to these advantages may be 
reasonably allowed, for an increased suscepti- 
bility consequent on Luxury ; in what her 
prurient desire for enjoyment may have 
added to comfort or necessity ; but, on the 
whole, the changes consequent on civiliza- 
tion, as regards primary impressions on the 
skin and lungs, must be evidently in favour 
of these organs. But, even were we to 
admit, that the influences of civilized life 

L 



146 



did in some points of view increase the sus- 
ceptibilities of the functions to which I have 
so far referred, or that they augmented, by 
their sympathetic connexion with it, the 
sensibihty of the cutaneous surface, still this 
appears to shrink into nothing when com- 
pared to the endless variety of condition, the 
interminable changes of action and sensa- 
tion, to which a perverted use of man's 
distinguishing attribute enables him to sub- 
ject the alimentary canal. 

Not content with satisfying the sugges- 
tions of Nature, by one kind of food, every 
meal often becomes the occasion of facti- 
tious stimulation. 

Sometimes by variety of condiment ; 
sometimes by direct stimuli. Does excite- 
ment produce weakness, the jaded organ is 
stimulated anew. If the ingenuity of the 
epicure, or the power of the gourmand, fail, 
medicine too often lends its aid as a soi- 
disant votary of science in the general work 
of excitement; and tonics, cordials, dinner 
pills, and a variety of ministerings to the 
fatigued sensualist, lull those healthy cau- 
tions, which the sensations of Nature sag- 



147 



gest, and sustain for a little, a transitory en- 
joyment, only more surely to complete a 
functional derangement which luxury had 
begun. 

Is this a true picture, or is it not? If it 
be thought untrue, I would answer, where 
is the medical man whose experience (and 
should I exceed the truth, were I to add, 
with regard to some at least, whose practice?) 
has not furnished examples of it, more or 
less abundant. 

It is humiliating to reflect, that truths, 
which should emanate from those who study 
the science to which they refer, should 
sometimes become popular, before they are 
acted on ; and that those, who should be the 
diligent observers and humble expounders 
of the laws of Nature, should sometimes 
first receive information from those who 
ought to be their disciples. To return : if 
the before-mentioned position be true, — and 
it is a truth that may well challenge enquiry, 
— we shall not long hesitate, to which 
organs we are most frequently to ascribe our 
diseases ; whether they be derived from 
primary impressions on those organs, or by 

L 2 



148 



that increased sensibility to primary impres- 
sions, which disordered organs confer on 
those with which they sympathize. If the 
fact, stated with relation to sympathies, be 
true, — if the representation of that compli- 
cated increase of injurious impression to 
which the digestive organs are subjected, be 
admitted, — the conclusion is unavoidable. 
Here, then, is an argument, a priori, in 
favour of the extensive influence of disorder 
of the alimentary canal, in more frequently 
increasing the susceptibilities of the organs 
with which it is disposed to sympathize; be- 
cause, whilst other organs, constituting the 
portals of the body, are in a comparatively 
natural state, as to external influences, 
having seldom to counteract any to which 
they are not necessarily or naturally ex- 
posed ; the digestive organs^ on the con- 
trary, are subject to every possible variety 
of adaptation of function, from factitious 
causes of derangement ; so numerous, and so 
varied, as to be alike but in one feature, that 
they are generally contrary to nature and 
to common sense. But is the argument, a 
priori, borne out l)y subsequent investiga- 



149 



tion ? I confidently reply in the affirma- 
tive. 

Any one, who will examine into the pre- 
vious condition of those persons who labour 
under any morbid condition, excited by 
change of temperature, will soon be con- 
vinced of the predisposing causes which I 
have mentioned, as well as the more fre- 
quent influence of that suggested by the 
condition of the digestive organs. Some of 
these are even popular already ; such as the 
susceptibility to cold during the operation of 
active medicines, as purgatives. I cannot 
here go further into this argument ; the facts 
are abundant and conclusive. I am content 
to rest it on the general view of the influence 
of the digestive organs, presented in the 
discourse which concludes this volume; and 
on the united observation and experience of 
mankind, w^hich, when once directed to a 
truth, seldom fail, sooner or later, to discover 
and adjust its real bearing and importance. 

In extending our considerations of sym- 
pathetic phenomena to the character, or the 
treatment, of disease, we find that, when a 
remedy is applied to an organ primarily 



150 



affected, it often not only corrects the dis- 
order of that organ, but also those sympa- 
thetic disturbances to which such primary 
affection may have given rise. 

We find also another very important fact, 
that this condition (of applying our remedies 
to a primarily affected organ), though the 
most desirable, where we can procure it, is 
by no means always necessary : on the con- 
trary, that it can be very frequently dis- 
pensed with altogether ; and that remedies 
applied to organs secondarily affected, or 
even where not visibly affected at all (sup- 
posing that they have a natural disposition 
to sympathize with those which are), become 
in many instances (provided the primarily 
affected organs receive no new cause of dis- 
turbance) equally salutary and effectual. It 
may be as well to illustrate these positions 
by a few familiar examples; and first, as 
regards 

Sympathetic Effects py^oduced through Organs 
primarily affected. 

If the chill of the skin be followed by 
an affection of the bowels, and this be re- 



151 



lieved by a warm bath, I consider both the 
remedy and the disease sympathetic*. If 
disorder of the stomach produce pain in the 
head, and this be reheved, — no matter 
whether by diet, abstinence, emetics, or 
cordials, — is not the disease and the remedy 
sympathetic, as regards the head? If, on the 
other hand, moral or nervous depression 
affects the stomach, and change of scene, 
quiet, and cheerful society restore it, are 
not the disease and the remedy sympathetic 
as regards the stomach ? 

But it may be said, this is all very well 
known ; but what I wish to impress is, that 
the corrective effects of sympathetic in- 
fluences, are by no means confined to those 
which operate on the organ which, so far as 
we can judge, appears primarily affected, but 
that they will, in many cases, exert a bene- 
ficial influence just as certain through 
organs which may be secondarily affected. 



* Though not the less real ; nothing appears to me a 
stronger proof that we bj no means bear in mind the import- 
ance of sjmpathv, than the simple fact, of the frequency with 
which we hear the phrase "merely sympathetic." 



152 



Syiufailietic Effects produced through Organs 
secondarily affected. 

If affection of the head produced cold 
feet, how is the head so frequently reheved 
by immersion of the feet in hot water, but 
by sympathetic effect on the circulation? If 
strangulated hernia produce, as we know it 
does, disordered state of the skin, and if the 
hernia be relieved whilst the patient is in 
the warm bath, how is this but by sympathy 
of parts secondarily affected ? In cold, 
threatening fever, how does an emetic so 
often relieve, especially as it is by no means 
restricted to cases where we can trace primiary 
disorders of the stomach? In asthma, the 
relief afforded by an emetic, and which 
again seems to operate by its effect on the 
skin, can only be referred to similar secondary 
sympathies. If the state of brain in fever 
produce sensibility of the eye and ear, 
rendering ordinary impressions in these 
organs not only painful, but capable of re- 
acting and exasperating the cerebral dis- 
order, and if darkness and silence be found 
to assist in quieting such disturbance, are 



153 



not both phenomena equally demonstrative 
of the influence of sympathy acting through 
organs secondarily affected? Occasional mis- 
takes throw light on the subject, and shew 
that the extreme of the principle, in demon- 
strating that we may act through organs 
which are secondarily or tertially affected. 

Many affections of the liver and bowels 
may be relieved by cautions and remedies 
addressed to the stomach. Disorders of 
the alimentary canal are frequently kept 
in check by spontaneous exertions of the 
skin and kidney. Affections of the sto- 
mach, occurring from sympathy with the 
uterus, strikingly manifest the benefit occa- 
sionally arising from directing our attention 
to an organ, to all appearance secondarily 
affected, where we cannot materially in- 
fluence the organ primarily affected. 

Affections of the testicle evidence the 
same fact. Often have I seen the most 
active local treatment of inflammation of 
the testes wholly inefficacious, in cases where 
it seems generally overlooked, that the spe- 
cific nature of the inflammation places it out 
of the pale mere anti-inflammatory treat- 



154 



ment ; whilst, in the same case, measures 
directed to the stomach and skin, have pro- 
duced most decided rehef. In my view, 
gonorrhoeal ophthahnia often supplies, under 
the rapid inducement of a peculiar state of 
constitution, a very powerful illustration of 
the same principle ; but, as the explanation 
is somewhat complex, I will not press it as 
an argument. 

How happens it, that vapour bathing 
effects so much good, in so many, such ob- 
stinate, and, I may add, such a variety of 
morbid affections, and this too, where we 
have no evidence whatever of the skin 
being previously affected ? In no other 
way, as I believe, than by the extensive 
sympathies of the skin, probably enforced, 
as the sympathies of this extended surface 
are, by their intimate connexion with the 
vast involution of it presented in the uri- 
nary, respiratory, and digestive organs. Mr. 
Green, the proprietor of the vapour baths in 
Great Marlborough Street (and who is also a 
surgeon), has published a list of cases, some 
of them patients of his own, in which the 
benefit of vapour-bathing is shewn to be 



very marked ; and, certainly, in some in- 
stances, where the circumstances were very 
inauspicious for the fair trial of any remedy. 
The cases referred to appear to me quite 
intelligible, when considered with reference 
to the sympathies of the skin ; but with this 
remedy, as with most others, the adjustment 
of its real claims is rendered different from 
very opposite causes : some expect more 
from it than it is capable of performing ; 
others employ it in cases where it is inappli- 
cable; and a third class obscure the sub- 
ject by neglecting those coadjutory mea- 
sures, on which the benefit of any remedy, 
applied to so important an organ as the 
skin, must, in a greater or less degree, 
depend. A vapour or warm bath is plea- 
sant and agreeable; but the regulation of 
torpid bowels is troublesome, and restric- 
tions in diet are unpopular. 

Many of my professional brethren have, 
in particular cases, felt difficulty in recon- 
ciling the effects of local remedies with the 
constitutional character of a disease. I 
cannot see the difficulty in question ; I 
think it just as intelligible as many other 



156 



pathological phenomena, which we have no 
difficulty in reconciling ; although, perhaps, 
in the strict sense of the word, we can be 
said to understand neither one nor the other. 
These effects, however, and the more cogni- 
zable, admitted phenomena of sympathy, 
seem to me mutually to reflect light on each 
other. 

Let us consider this a little in detail. 
The whole body has sympathy with every 
part, doubtless. Every part, too, has its 
own preservative actions. These preserva- 
tive endeavours seem, for the most part, 
resolvable into one or two principles. 
Either a diminution or arrest of function, 
or an increase of it, so far as may be neces- 
sary to expel or overcome the exciting 
cause, whether mechanical, chemical, or 
sympathetic ; or, if the process be de- 
structive, to limit its operations, or transfer 
it to less important, or more highly organ- 
ized parts. To illustrate these positions, it 
may be observed, that the preservative ac- 
tions of glandular structures are chiefly se- 
cretory ; as in the salivary glands, liver, or 
kidney. The stomach has the power of re- 



157 



lieving itself in many ways ; by secretion, 
by rejection of what it has ah^eady taken, 
or by a suspension of function, as in re- 
fusing to take more ; and by exciting one or 
other organs to its assistance in one or all 
of these actions ; as tlie gustatory sense, in 
nausea. Cellular tissue, bone, and the more 
usual seats of diseases called local, have also 
their preservative actions. That generally re- 
quired is reparative, as in breach of continu- 
ity ; but they have also preservative actions. 

Cellular tissue exhibits this, when it cir- 
cumscribes injurious actions by adhesive 
inflammation. The skin, too, has its pre- 
servative modes of disposing of local irri- 
tation ; sometimes, by diffusing it over a 
large surface ; somiCtimes allowing, in con- 
junction with cellular tissue, its concentra- 
tion in one part, where it is removed from 
important structures and yet near the 
sources of circulation, which experience 
shews to be spots most favourable for repa- 
ration— as in boil ; more strikingly still in 
carbuncle. Even in bones, whose preserva- 
tive powers are of a low order, but exactly 
analogous in kind with every otlier j)art, 



158 



we see a disposition to transfer diseased 
actions to other more powerfully vital parts, 
as if they were more capable of coping 
with it. We see this in the abscesses of 
soft parts, connected with symptoms of ir- 
ritation in bone, where a timely division of 
superjacent structures prevents the threat- 
ened mischief to the less highly organized 
part. 

Now, if we apply these remarks to the 
action of local remedies, where is the differ- 
ence between skin, cellular tissue, or exter- 
nal parts, and the internal- organs. If the 
stomach, or general nervous derangement, is 
capable of disordering the liver, it will not 
be denied that this is, to all intents and pur- 
poses, a constitutional affection ; yet so far 
is it from making remedies applied to the 
liver useless, that they will frequently them- 
selves correct the disorder : yet the appli- 
cation shall be local ; or, if no first excite- 
ment be given by the stomach, it mayj to 
keep the reasoning clear, even be in the 
form of external application. So, in many 
local diseases involving breach of surface 
or continuity, remedies applied, will often 



159 



induce healthy actions ; when, neverthe- 
less, the cause has been altogether consti- 
tutional. 

Again, how does a ])oultice give relief 
in gout? This is surely a constitutional 
disease. It is very true, I believe, that local 
remedies will not cure diseases whilst the 
constitutional causes are still in operation ; 
neither will remedies directed to the liver, 
which has been disordered by derangement 
of stomach, relieve it entirely, if the sto- 
mach be allowed to be the channel for re- 
newed provocation. 

In the treatment, however, of diseases 
occurring on the surface of the body, the 
error of the constitution is sometimes cor- 
rected by the very occurrence of the dis- 
ease in question ; and this leads those, 
whose habitual reliance on their visual, 
creates a tendency to the exclusion of their 
intellectual perceptions, to infer that the 
disease was local. Now, were it not that 
sympathy confers on the part the power of 
a reaction on the constitution, or for the 
continued provocations to which the consti- 
tution is usually subjected, it is probable 



160 



that a great many more local diseases than 
we can find examples of at present, would 
yield to local treatment ; for they always 
appear to be efforts of Nature to throw off 
general disturbance ; though, by a strange 
oversight, we are never so blind to her pre- 
servative power as when she is successful in 
the exercise of it. How many cases are 
there in which the mere inefficiency of local 
remedies has been the very thing which has 
led to their entire rejection ; and, in many 
of these cases, of what has the constitutional 
treatment consisted, but in avoidance of 
sources of excitement, which the patient's 
feelings and experience may have suggested 
as improper for him, and productive of 
mischief. 

Sympathy, to my mind, appears to ren- 
der all this sufficiently intelligible. The 
preservative power transfers general dis- 
order to a local seat, as offering a part, per- 
haps less important, or as capable of taking 
on actions which could not take place, in 
organs essential to vitality, without annul- 
lino" their functions. If no fresh disturbance 
take place, the sympathy of that part may 



161 



not be i^eciprocal, or only in a slight degree, 
producing a moderate excitement favour- 
able to its own work ; a state of things 
sometimes seen in common boil : or the 
local disturbance may be so great as to 
make it react on the constitution, as in car- 
buncle. Does any one, at this day, con- 
clude, from the extreme benefit attending 
the free and deep divisions of carbuncle, 
that it is a local disease ? 

If diseases of external parts can be 
proved, — as in gout, many ulcerations of the 
extremities, boil, catarrh, — to be efforts of 
Nature to relieve the constitution why 
should we think that she pursues a different 
law with other affections of the surface? 
Do we find her, in other departments of 
the creation, varying her laws for the adop- 
tion of a single object ? I think not. We 
often find her exemplifying, in a marvellous 
diversity of phenomena, the application of 
a single principle ; but I know of no in- 
stance of her accomplishing one object by 
a diversity of laws. Why some diseases 
should be fatal, — in other words, why the 
preservative power of the body siiould be 

M 



162 



limited, — is just another way of asking why, 
as I have before observed, death, as well as 
life, is a law of our nature. 

But, even in fatal diseases. Nature is still 
consistent. We see types of her preserva- 
tive power even to the very last, and always 
characterized by attempts to transfer dis- 
ease to less important organs. To the 
bowels, skin, and cellular membrane, in 
phthisis ; to serous membranes in diseases 
of the heart ; and often, as we know, with 
sustaining power delaying that, of which her 
own laws forbid the entire prevention. 

In diseases, too, of the heart and arte- 
ries, and in the progressive absorption in- 
duced by the pressure of aneurisms, and in 
affections of the skin, in an enlarged sense 
of the term, we see the same principle in 
operation. 

To return for a moment to local reme- 
dies. Is cancer a constitutional disease? 
yet we relieve its pain by local remedies ; 
and I may remark by the way, that the facts 
at present known, of which I have expe- 
rienced some myself, induce me to hope 
that, at no distant period, we shall, by judi- 



163 



cioiis constitutional measures, succeed in 
relieving it altogether. We, however, re- 
lieve it by local remedies. But the cases 
where the benefit of local measures in af- 
fections, markedly constitutional, are best 
seen, are those presented by diseases of 
joints. A man has disease in his knee, his 
diet has been attended to, his secretions 
improved, his knee leeched, perhaps coun- 
ter-irritants applied, and he is better ; but 
still his tongue is white, his pulse indicates 
excitement, he has still some pains, and 
his nights are indifferent ; you put him in 
splints, keep the joint steady, and every 
thing wears a new face in twenty-four hours. 
This is the case where the local remedy is 
superadded to the constitutional. The ef- 
fect is sometimes equally marked in the 
employment of counter-irritation. Of both 
I have seen repeated examples ; they must 
be known to every one, especially those who 
conduct the local treatment of joints with 
strict attention to splints, as taught by j\Ir. 
Abernethy. Yet who dreams, therefore, 
that the disease was local ? 

In the common porrigo, it is curious to 
M 2 



164 



see the obscurity which men make for 
themselves, with regard to this disease (in- 
tractable occasionally, certainly, but, as I 
have endeavoured to shew elsewhere, less 
obstinate than most other cutaneous dis- 
eases, when properly treated), by sup- 
posing it local, because it is, in many cases, 
remediable by local remedies ; but, looked 
at in this way, it is an obstinate disease, 
and will continue to be so, until, like many 
others, which an improving science has so 
arranged, it shall be numbered, by general 
consent, amongst the diseases of constitu- 
tional origin. I will, however, press the 
point no further ; it must be left to time, 
and the slow operation of experience and 
reflexion. 

So far in explaining the action of re- 
medies. I now proceed to apply the doctrine 
of sympathy to the treatment of diseases. 
First, as bringing diseases under our con- 
trol, which I contend are often not so, when 
otherwise treated. 

Secondly, as relieving those, without pre- 
judice to the constitution, which are gene- 
rally treated by means, which, there is the 



165 



strongest reason for believing, produce fu- 
ture consequences much counterbalancing 
the present advantage ; and 

Thirdly, as acting in a way, whilst it 
does not diminish the paramount import- 
ance ; and, consequently, our search after 
primary impressions shall still modify our 
application in a way not hitherto suffi- 
ciently, or, as I believe, at all attended to, 
on scientific principles. 

As brincrino; diseases within our control 
usually not so when otherwise treated. This 
includes a variety of local disorders de- 
pendent on derangement of the digestive 
oro'ans, as well as affections of these oro:ans 
where they have not produced local dis- 
eases. In cases, in fact, where you have in 
vain tried to correct the constitutional dis- 
order by means directed to the organ, to all 
appearance primarily affectedj you address 
yourself to organs with which it has known 
sympathies ; and, by exciting those v\ here 
there appears to be deficient action, or 
soothing them where the action appears to 
be excessive or irregular, you either at once 
obtain the benefit you require, or do it 



166 



secondarily 5 by rendering the primarily af- 
fected organ amenable to influences before 
inefficiently employed. 

I have seen many cases of ailing indivi- 
duals, whose disorders have been ill defined, 
as well as others, in whom the symptoms 
have been more pointed as regards particular 
organs, which have owed their relief to that 
extension of the constitutional treatment, 
which consists in working through different 
sympathies ; and I beheve that the occa- 
sional good effects of quack medicines result 
from their acting through some sympathy 
which had not been previously acted on. 
It is certain that those which have been 
most accredited, operate in this way ; for 
they usually produce violent effects either 
of skin, alimentary canal, or kidney. A 
few random shots, however, if successful, 
appear to afford a very inadequate compen- 
sation, either as regards the public or the 
interests of science, for the mischief annu- 
ally perpetrated by these scourges, under 
the protecting auspices of ignorance and 
credulity ; and, in some sort also, those of 
a Government, who, for no other reason 



167 



that I can perceive, but an inconsiderable 
revenue, allow of a system alike injurious to 
the public health, and unworthy of the 
guardians of a great empire*. 

To return, however, to sympathy: I know 
it is difficult to prove any proposition, in a 
science so far from exact, as that of medicine 
or even surgery ; but I will not attempt to 
prove. I shall be perfectly satisfied if I can 
illustrate what I mean ; because I rely on 
the profession for trying its practical appli- 
cation, and I rely on its practical application 
for adjusting its truth or value. The ad- 
vocacy of one man will never establish an 
opinion : it would be very injurious if it were 
so. Every one knows how Mr. Abernethy's 
opinions were first received, both as regards 
the treatment of disease, the nature of life, 

* The glaring absurdity and injustice of requiring one set 
of men to incur tlie expense of a liberal education, and an 
examination, before they can prescribe the most simple me- 
dicine ; and, on the other hand, allowing any one, without 
any education at all, to sell any nostrum he choses, on paying 
a stamp duty ; although the composition of the nostrum is 
avowedly concealed ; is surely one of the most monstrous 
abortions ever presented by the exuberant fecundity of legisla- 
tive conception. 



168 



electricity^ &c. Only contrast their reception 
with the facts revealed by science since that 
time ; and if any thing could induce us to 
wish him back, it would be, that he might 
enjoy the intellectual triumph which pro- 
gressing science had prepared. I will now, 
then, relate a case or two : 

A lady applied to me, for symptoms 
which appeared to be connected with 
primary hepatic disorder, a consequent 
much-disordered state of the bowels, evi- 
dently connected with, if not dependant on, 
mechanical obstruction by stricture. Her 
countenance was yellow, as were the con- 
junctivas. She had a variety of strange ner- 
vous sensations, in different parts of the 
body; sometimes pain in the head, with 
threatening loss of consciousness, or faint- 
ing ; sometimes cramps, pains in the loins ; 
peculiar sensations referred to the uterus: 
in fact, I can hardly recollect the variety of 
morbid sensations of which she complained; 
for a fresh visit would sometimes develop 
something new in this way. She had been 
attended by a gentleman, who seemed dis- 
posed to refer her symptoms to the uterus. 



169 



She was about the af;e when the catainenia 
disappear; and she saw nothing, except, now 
and then, a shght muco-sanguineous dis- 
charge, in a small quantity, and occurring 
after lono; and irre^^ular intervals. Her 
tongue was furred; her appetite failed; sto- 
mach uneasy and flatulent, bowels obsti- 
nately costive^ and when they did act, it was 
under the influence of medicine, and with 
pain. Her diet was attended to very strictly, 
and she was allowed but a measured quantity 
of meat. Her bowels were acted on by 
aperient medicines, in graduated doses; and 
the stricture of the rectum relieved by bou- 
gies of varying diameter : an abscess which 
formed was opened early; and though it 
threatened fistula, yet it did not occur. Her 
liver, however, would not secrete properly, 
and, therefore, neither her bowels nor her 
stomach got right. She had a great sus- 
ceptibility to mercury, which invariably dis- 
agreed with her — first, by not acting on the 
liver, and then by inducing so much depres- 
sion of the nervous system, as always to do 
more harm than good. She took various 
things as substitutes for it ; and. amongst 



170 



others, the compound extract of colocynth 
and nitric acid ; but no success attended 
these endeavours ; directed to the liver, from 
its disorder not only appearing, from the his- 
tory, to have been the primary one, but as 
being remarkable at this time, and obviously 
competent to account for the disorder of 
the bowels. 

There now remained no evidence of 
difficulty of a mechanical kind; and, under 
these circumstances, she was treated by 
attentions to the organs secondarily affected. 
No attention of any kind was paid directly 
to the liver: whenever she took aperients, 
they w^ere of a kind to act chiefly or wholly 
on the bowels ; the action of them being for 
the most part trusted to aperient enemata, 
alternately, with more frequent injections of 
warm water merely. Her diet was very 
sparing in quantity, and cautious as to its 
selection. Her skin was acted on by warm 
clothing, and vapour bathing. In a com- 
paratively short time, she improved; her 
bowels became more tractable, her biliary 
secretions regular. She lost a highly painful 
affection of the rectum, exceedingly in-- 



171 



creased on the expulsion of the feces, and, 
in short, got so well, as to carry in her 
appearance no evidence of disorder. As 
she had no opportunity of taking the ex- 
ercise which she had been recommended, 
she is still obliged to attend to her bowels, 
and to assist them by such alternations of 
enemata of warm water, slight aperients, or 
little occasional variations in diet, as her ex- 
perience may suggest to her ; in other 
respects she is well. 

About six years ago, a lady, set. 42, 
consulted me, chiefly, I believe, for what she 
conceived to be an affection of her head, 
characterized by constant noise and frequent 
giddiness, which was so distressing that she 
had relinquished going out, in consequence 
of the constant fear of falling in the street. 
Her tongue was furred, her bowels ir- 
regular ; her appetite not very good. She 
had not menstruated for some months, ex- 
cept a small appearance at irregular in- 
tervals. Menstruation had not commenced 
until she was 19. Her extremities were 
generally cold, and she complained of pains 
shooting across the upper part of the ab- 



172 



domen. She had been under the care of a dis- 
tinguished physician ; but some one having 
suggested that her complaint was surgical, 
she applied to me. I found that she had 
been four months under the care of the 
physician in question ; but that she felt worse, 
rather than better. As she positively de- 
clined acceding to m.y wish for a consulta- 
tion, I was obliged to gather her previous 
treatment from her own account, and from 
the prescriptions she submitted to my 
perusal. I found that she had had a few 
leeches applied once to her temples; but no 
other depletion : the treatment, on the con- 
trary, consisted of emmenagogues,aloes5 steel, 
and myrrh, with stimulants, camphor, car- 
bonate of ammonia, &c. She was advised to 
eat meat, and to drink wine and water. 
As I could not agree in any part of this 
treatment, I again proposed a consultation ; 
but she refused: on which I told her that 
my reason was, that my views of her case 
induced me to recommend a very different 
course; and that, as her case was one usually 
submitted to a physician, it vv^ould be more 
satisfactory to both parties. As she only 



173 



answered this with general expressions of 
confidence, I proceeded with the treatment. 
This consisted of venaesection, in the first 
place ; followed by occasional application of 
leeches to the temples. Enemata of warm 
waterj immersion of the feet in warm water 
and mustard, and aperients with calomel and 
antimony, and, subsequently, of antimony 
and colchicmii. The biliary secretion was 
very much disordered ; and mercury in any 
shape depressed her exceedingly, as did the 
abstraction of blood. The only form in 
which mercury seemed to be borne, was in 
combination with quinine; and, even in this 
way, it did not act very kindly, generally 
appearing to produce a fidgetty kind of ex- 
citement. She, however, got quite well by 
the adoption of the foregoing measures, to 
which was added a very cautious diet, absti- 
nence from wine and stimuli, and daily ex- 
ercise, either by walking or taking an airing 
in a carriage. On leaving her, I gave her 
very full directions, how she was to proceed 
to prevent a recurrence of her disorder; but, 
although an excellent patient as regarded 
obedience, wlien left to herself, she was 



174 



constantly prevailed on to commit errors of 
one kind or another; and her own inclination 
rather led her to neglect exercise, with the 
importance of which I had endeavoured es- 
pecially to impress her. She had two re- 
turns, one of which commenced by her 
falling forwards in a carriage in a fit of gid- 
diness, from which, however, she again re- 
covered, once under my care, and once 
under the care of another gentleman, who 
requested my assistance in consultation. At 
length, she sent for me a third time, when I 
found she had been again ill, and had con- 
sulted a very popular physician, who recom- 
mended ammonia and stimulants, and that 
she should drink a certain quantity of rum 
and milk every morning. These measures 
appeared to have reproduced all her former 
symptoms, accompanied by others of a still 
more serious character. I found her labour- 
ing under flatulency, great pain across the 
abdomen, and tenderness on pressure; great 
prostration of strength ; her countenance 
shrunk, a dark halo around her eye^ her 
pulse extremely feeble; her stomach reject- 
ing every thing, and altogether in an ap- 



175 



parently dying condition. She evidently 
thought herself dying. She thanked me for 
mj former attention to her, and formally 
took leave of me. I endeavom'ed to inspire 
her with some hope; but, to say the truth, I 
did it but faintly; for I had none myself. 
As I wished to do something to relieve her, 
if possible, and, as any active measures 
were out of the question, and as I could not 
but think, from all I had seen of her case, 
that the alimentary organs were materially 
influential in producing her present depres- 
sion, I merely ordered warm enemata to 
assist in the expulsion of air, or any of the 
contents of her bowels ; and, as her stomach 
would take Jiothing, I desired that the ene- 
mata might be composed of gruel. She had 
also a mixture of inf aurantii, with a little 
confect. aromatica; a very small quantity of 
which was to be taken every now and then, 
if, on trial, it appeared to relieve her. The 
next day she was much in the same state. 
On this occasion I examined the abdomen, 
and, in consequence of something she said, 
the rectum also. The liver appeared de- 
cidedly enlarged, and some chronic affection 



176 



of the uterus (as I suppose) produced a very 
palpable projection towards the rectum ^ but 
not so as to produce any mechanical obstruc- 
tion. Although she was scarcely better, 3'et 
she had not sunk any lower; and as the state 
of the stomach, the disease of the liver, and 
her peculiarity with regard to mercury, 
seemed to forbid any thing directed to these 
organs, I confined my attention entirely to 
the bowels. She certainly was allowed to 
take very minute quantities of weak gruel, 
two or three times a day, but the bowels 
were made the channels, both for medicine 
and nutriment. They were kept clear by 
copious enemata of w^arm water, briskl}' in- 
jected by the syringe; and, at convenient 
intervals, moderate quantities of gruel and 
soup were thrown up with gentleness, so as 
to induce their retention. For the first few 
days, there was but little improvement, not- 
withstanding that some very unhealthy 
faeculent matter had been discharged. She 
then, however, began to rally, her features 
improved, the tenderness and pain disap- 
peared ; but she was still extremely weak. 
She was now ordered very minute quantities 



177 



of isinglass jelly, administered by the sto- 
mach, which was gradually alternated with 
minute portions of bread pudding; and, as 
her appetite returned, this was extended to a 
mild nutritious diet. The improvement now 
continued, and she was in a few weeks per- 
fectly well. She is now very particular in 
her living ; that is, she eats plain food, and, 
by her own wish, has relinquished wine 
altogether, of which she had been accus- 
tomed to take two glasses daily. I lately 
saw her, and she remains perfectly well ; 
the only plan being the caution I have men- 
tioned, and a little aperient medicine when 
she finds her bowels acting indifferently. 
To me the case is very striking; I know not 
if it be so to the reader. How was the case 
relieved, but by sympathy ? Considerately 
looking to all the circumstances, one could 
scarcely conceive one more unfavourable 
for any plan, much less one which consisted 
only of such apiJarently simple measures. 

The following case I have in pare men- 
tioned elsewhere, with a view of illustrating 
the fact, that often, where the primary im- 
pression has been addressed to the nervous 

N 



178 



system, our chief means of tranquillizing it 
consist in guarding it against fresh sources 
of excitement, and especially those resulting 
from disturbance of the chylopoietic viscera, 
in the manner dwelt on by Mr. Abernethy. 
But the case, also, exemplifies how, when we 
have no means of addressing our remedies 
with effect to the primary organ, we may 
succeed in relieving it by attention to other 
organs with which it has a marked sympathy. 
A young woman received a severe shock, in 
going into a room, where, without her being 
previously aware of it, lay a corpse; she 
instantlv fell down, and it was some time 
before she recovered her senses. She con- 
tinued in a very nervous state, subject to 
frequent palpitations, and with cessation of 
the catamenia for several months. At this 
period, her leg began to exhibit a varicose 
state of the veins ; and, two years from the 
commencement, and when I first saw her, 
the whole leg from the ankle to the knee 
was covered by as large a mass of diseased 
veins as I have ever seen at any age. Her 
bowels had been habitually costive for many 
montlis ; so that, until lately, she had been 



179 



obliged to have constant recourse to ape- 
rient medicine. About six weeks previously 
to my seeing her, she struck her leg ; an 
ulcer formed ; and, as it did not heal, she 
applied to the Dispensary. Her pulse was 
very frequent and hurried, her tongue furred, 
her appetite deficient ; but, since she has had 
the ulcer, she says her bowels have acted 
regularly without medicine ; catamenia ir- 
regular. Here the nervous and vascular 
system became disordered, in the order 
which I have mentioned ; subsequently the 
digestive organs, which to a certain extent, 
were again relieved by the accidental local 
malady. The treatment of the case was 
wholly directed to the chylopoietic viscera, 
to ensure the regularity of their functions, 
to diminish their labour, ^nd avoid dis- 
turbance by plain food, and in moderate 
quantity. She not only completely re- 
covered, but the case presents a feature 
which I never recollect seeing before: viz. 
the last time I saw her, the enormous masses 
of diseased superficial veins seemed to have 
become firm, far less prominent, and ap- 
peared evidently in progress of obi iteration. 

N 2 



180 



This surely is acting on organs secondarily 
affected, and seems to me a very interesting 
example of it ; however, the reader must 
form his own conclusions. 

A case occurred in the Dispensary very 
lately, and I mention it because the woman 
is still occasionally coming to the Institution, 
and, therefore, may be seen. She came with 
a large, superficial ulceration in the left leg; 
completely occupying the whole limb, from 
the knee to the ankle. She was desired to 
rest, poultice, and attend to her diet and 
bowels. I was talking about sympathy to 
two gentlemen who were sitting with me 
at the Dispensary, when the next patient 
happened to be this old woman, aet. 72 ; and, 
in explaining how they should examine 
cases, I said, there now is a case, which, 
though common enough, yet presents one 
feature, sui^oestinp; a consideration not usu- 
ally belonging to that class of case. 

The very large surface of skin thus af- 
fected, from what you know of burns, 
would suggest the probability that some part 
which sympathizes with the skin will here 
be well marked. Now, said I, first try the 



181 



alimentary canal. Her tongue was not 
good, nor much otherwise. Appetite good, 
and bowels regular. Now, said I, it does not 
follow, because of this, that the alimentary 
functions should be healthy ; but let us 
now enquire about the kidney. We found 
that she made a very small quantity of water 
indeed, and that, generally very thick ; but 
every now and then, she said, she made a 
very considerable quantity of pale urine. I 
now said to the pupil, just act a little on her 
kidney, and see the effect on the leg ; but 
let her omit all her other medicine, and 
only take a diuretic. 

The next time I saw the woman, her leg 
was entirely healed, the whole surface having 
cicatrized in about a week. We all thought 
the case was very striking* Her kidney act- 
ing naturally, the diuretic was discontinued. 
In about ten days the leg again became 
uneasy, and some pimples appeared on it ; 
the bowels were acted on a little more 
freely, and these pimples disappeared ; but 
the leg still continued very hot and painful, 
and seemed to threaten, by its increase of 
temperature, some further local disturb- 



182 



ance. The medicine directed to her kidney 
was again employed, and the uneasiness of 
the leg again subsided. This old woman 
labours under a great deal of functional 
disorder, and, at her advanced age, it is not 
to be expected that any treatment will be 
long effectual. To use her own words, she 
feels very much better, but she does not 
expect to be made young again. 

A disease, which frequently illustrates 
the advantage of treating a case by the 
sympathies, is strumous ophthalmia. The 
disease itself is, indeed, sympathetic ; for it 
generally results either from disorder of the 
mucous surface of the bowels, from irrita- 
tion of the stomach, or from injurious in- 
fluences applied to the skin ; frequently 
from the combined influences of all these 
circumstances. Treated in the wav which I 
believe is now that generally adopted, the 
inflammatory symptoms are easily checked, 
and the characteristic irritability subsides as 
soon as the digestive organs have been set 
right as to the regularity of their action, 
and the nature of their secretions ; but, 
nevertheless, we occasionally meet with 



183 



cases where the disorder of the ahmentary 
canal proves unusually obstinate, or where, 
although this be corrected as far as regards 
the usual indications of its disorder, still 
the irritability of the eye remains, and ob- 
stinately resists the usual treatment. Under 
such circumstances, we often derive perfect 
success from very simple resources, and 
which can, I think, only operate through 
the sympathies. Of this I have seen many 
examples^ although the mode of exempli- 
fication has been different in different cases ; 
but in no one more commonly, than in that 
shewn in the following case. 

A little girl, whose case would be but a 
detailed enumeration of the facts above 
referred to, and who had been treated in 
the usual mode, including the most accu- 
rate attention to means calculated to ensure 
tranquillity of the alimentary canal, still 
had as much irritability to light, as we find 
in the worst cases of this kind. As she 
had, at the time, counter-irritation behind 
the ear, it did not seem a particularly fa- 
vourable case for the remedy about to be 



184 



mentioned ; but as almost ever}'' plan had 
failed, mercury inclusive, and as I had seen 
the greatest benefit derived in correcting 
disorders of stomach by the remedy in 
question, and by which disorder I consi- 
dered that the irritability of the eye was 
maintained, I ordered the counter-irritation 
behind the ears to be allowed to heal, and 
then directed a tartar emetic plaster to be 
put on the epigastrium. In three days she 
would face broad day-light without incon- 
venience, and her case became as tractable as 
any ordinary case of the kind. Now, here the 
stomach, I have no doubt, was disordered ; 
but we could not get it right ; the impres- 
sion on the skin in its neighbourhood, just 
gave the required turn to the case, and sub- 
dued a difficulty which, before this, appeared 
insuperable. I could relate various cases 
illustrating this subject ; but the cases must 
be seen to produce conviction, whilst, for 
mere purposes of this part of the subject, 
these will suffice ; and the increasing num- 
ber of pages warns me that I am already ex- 
ceeding the limits I had proposed to observe. 



185 



As relieving diseases, on which we have 
at present power, by means less injurious 
to the constitution. 

Nothing appears more certain than that 
the phenomena of sympathy have not been 
apphed in the manner, or to the extent, of 
which they are susceptible ; or than that, 
where they have been applied, either on the 
suggestions of the sensations, as happens in 
some popular remedies, or in that confined 
view of disease which leads men merely 
to treat symptoms ; that they have, never- 
theless, under both these disadvantageous 
circumstances, been often productive of very 
material benefit. 

No man can do more than speak from 
his own observation and experience ; but, 
so far as mine has gone, very little attempt 
has been made to render the sympathies as 
available as they might be ; and thus a 
powerful means of counteracting disease 
has been overlooked or abandoned ; and, 
too frequently, just at the time when the 
observation of its phenomena becomes most 
necessary, deductions, alike legitimate and 
useful, have been overlooked, and their 



186 



place supplied by an appeal to a desperate 
empiricism ; always a humiliating necessity, 
and not to be thought of until we have well 
ascertained that Nature no longer affords 
any suggestions for our guidance, which 
the present state of our knowledge allows 
us to understand. The inexactness of 
medical and surgical science, no less than 
the laws of life and death, too frequently 
impress on us the small extent of our 
knowledge. But still, it is to be feared 
that a prurient desire for short roads 
to success, frequently overcomes that pa- 
tience and steadiness which are necessary 
in discovering the suggestions of Nature 
lono; before she ceases to manifest such suo;- 
gestions. No sooner has some treatment, 
directed to a particular organ, been found 
unsuccessful, than, instead of more enlarged 
views being taken, and attempts made to 
produce changes, by the intervention of 
sympathetic actions in other organs, either 
the dose of medicine, which hitherto has 
failed, is enormously increased, or remedies 
are employed on grounds purely empirical, 
and of a description which, to say the least 



187 



of it, mast be calculated to induce injuriouL> 
effects on the constitution, even though they 
may be attended with beneficial effects, as 
regards the present symptoms of particular 
organs. 

To exemplify what I mean, I may men- 
tion some of the remedies, which, though 
no doubt often highly useful, are never- 
theless too frequently employed in the 
manner to which I have alluded. Calomel 
and opium, mercury generally, colchicum, 
croton oil, strychnine, kreosote, prussic acid, 
argenti nitras, narcotics, opium generally, 
and many others. 

I must take this opportunity of observ- 
ing, that there is no one more abundant 
source of error than the idea (a very natural 
one I admit) that a course, which soonest 
relieves a prominent or troublesome sym- 
ptom, is necessarily the best practice. That 
this conclusion is not only erroneous, but, 
in its prospective results, often highly mis- 
chievous, is, in many cases, subject to the 
clearest demonstration. Nevertheless, the 
inconceivable difficulty of impressing the 
minds of many persons with this fact, in a 



188 



manner commensurate with its importance, 
can perhaps only be understood by the dif- 
ficulty which many have experienced in es- 
tablishing it in their own ; nor is this, perhaps, 
to be wondered at, since, although the cases 
are numerous enough, which shew that 
measures attended with immediately flatter- 
ing results, are nevertheless exceedingly 
detrimental in their consequences ; yet, on 
the whole, perhaps, they may be regarded 
as exceptions. No one remedy appears to 
illustrate the fact in a more intelligible or 
indisputable manner than the abstraction of 
blood ; however important and necessary it 
may be, when properly employed, it is even 
in such cases often productive of much 
subsequent mischief. But there are many 
affections in which it is often unnecessary, 
yet wherein it is a sure remedy for the 
more prominent symptom, and where it 
thus holds out an equal temptation to the 
patient and the practitioner. To the former 
it promises immediate relief, and perhaps 
an immunity from troublesome restric- 
tions ; to the latter it promises a quick suc- 
cess, the best security against a vacillating 



189 



confidence, which may not know liow to 
discriminate, much less to value that stea- 
diness which sacrifices a temporary success 
to procure a permanent advantage. The 
disorders to which I allude, are congestive 
determinations to the different viscera. The 
ready relief which bleeding affords in cere- 
bral congestion, in many kinds of dyspnoea 
and hepatic congestion, is well known ; and 
yet it would be by no means difficult to 
prove, that, with the exception of those 
cases in which the congestion so borders on 
inflammation, as not to be certainly distin- 
guishable from it, or where it threatens ef- 
fusion, bleeding is alike improper in all of 
them. 

That it does not minister to the origin 
of the disease is clear ; that, casteris paribus, 
it accelerates its return, is so well known as 
to have become popular ; and that by any 
easy and too prevalent transition, it lays 
the foundation for the most perplexing dis- 
orders of the nervous and vascular systems, 
chiefly characterized by an endless variety 
of irregularities in the circulation, a grow- 
ing accuracy of observation is daily unfold- 



190 



ing to us. It seems to me, that both the 
pubhc and the profession are much in- 
debted to Dr. Marshall Hall for the light 
which he has thrown on this subject. 
But, although the abstraction of blood 
affords numerous illustrations of a remedy 
which immediately relieves a particular 
symptom, not constituting always the treat- 
ment best adapted to the state of the 
body which that symptom may characterize, 
still there are many other facts equally 
instructive. Acidity of stomach will be 
immediately relieved by an alkali ; but 
every one knows that this remedy will not 
prevent its return ; and those who have had 
an opportunity of witnessing it as a habit 
of years, know that it has seldom failed 
materially to embarrass the functions of the 
stomach. I need scarcely observe that the 
proper measures in such cases consist in 
preventing the acid being formed, not the 
mere neutralization of it when secreted. 
A moment's reflection would shew that 
such a step is not likely to relieve the real 
disease ; experience makes it a matter of 
demonstration. I do not say it may be 



191 



improper, in combination willi otlier more 
efficient treatment, to endeavour to relieve 
the state of stomach in question by the 
alkaU ; yet, to trust to this alone, is evi- 
dently as unscientific as it is manifestly 
injurious. No affection is more surely re- 
lieved in the majority of cases, by studying 
the peculiarity of the stomach, than that 
in which the practice I would deprecate is 
more prevalent. How many states of sto- 
mach are there, relieved soonest by brandy, 
wine, or other remedies more generally 
known as medical stimuli. Yet I believe 
that few sources are more prolific in their 
injurious consequences than such practice. 
The dram-drinker is but a melancholy ex- 
ample of its operation. The unfortunate 
who rests his nerves on laudanum, is too 
often a victim to the same principle ; al- 
though the original intention in this case, 
as well as the effect, may have been different 
from that of stimulus. 

The hasty conclusions, of which I have 
endeavoured to shew the fallacy, are furtlier 
injurious, from the flattering results which 
they present, frequently closing our eyes or 



192 



lulling our vigilance with regard to the cau- 
sation of disease. 

What has been said of bleeding, the 
employment of alkalies, and stimuli in sto- 
machic affections, appears to apply with 
equal force to the use of mercury ; and I 
mention this particularly, because it is a re- 
medy which I am obliged to employ largely 
myself in inflammations of the eye and 
other organs; I need not say with how 
much good, since every one knows how 
effectual mercury is in such cases. All this, 
however, is perfectly consistent with the 
conviction, that, in many cases, the remedy 
thus successfully employed, is attended with 
ultimately prejudicial effects on the consti- 
tution. Why do I then employ it ? Be- 
cause the disease is one of rapid progress ; 
a membranous inflammation is progressing, 
which will involve the organs to which it is 
contiguous ; my first object is to preserve 
life, or, if the disease be in the eye, an organ 
so valuable as scarcely to be inferior to life 
itself ; and where even the most favourable 
results of inflammation, if it do not destroy 
the several structures of the organ, properly 



193 



so called, will spoil it as an o]}tical instru- 
ment, by obscuring certain transparent and 
refracting media, no less necessary to its 
functions. Here, then, we meet with a 
combination of circumstances, which, in the 
j^resent state of knowledge^ affords us no 
choice ; and by an easy, but I must con- 
tend, a very mischievous transition, we ap- 
ply the same measures, where we have 
plenty of time for trying others less pre- 
judicial, and which, on trial, will be found, 
in many cases, most completely successful. 

If, for example, the case be disorder of the 
liver, we are too apt, on finding certain doses 
of mercury ineffectual, to employ larger and 
larger, when we ought to try to work the 
liver by exciting organs with which it has 
a known tendency to sympathize ; practi- 
cally, we sometimes aid the effect of this 
very remedy by means addressed to the 
skin ; as in the confinement of the patient 
to a certain temperature. But, although it 
would be wrong to recommend any thing 
at present, which should delay measures 
which experience has shewn to be capable 
of producing desirable effects on the minute 
o 



194 



vessels of the body in active inflammation, 
threatening alteration of important struc- 
tures ; yet, in more chronic forms of diseases, 
much more good may be done by measures 
less prejudicial than is generally imagined; 
of which the following case is an ex- 
ample. 

A man applied to me, at the Finsbury 
Dispensary, with a state of eye character- 
ized by the following symptoms. The cor- 
nea was slightly cloudy, so was the pupil ; 
he saw every thing as if covered with a 
cloud ; had some pain in the head, and 
rather a dilated pupil ; the eye generally, 
wanting expression. He had applied to me 
two, if not three times before, at intervals 
of about twelve months ; and on each occa- 
sion, after a few preparatory measures, he 
was cured by the cautious application of 
mercury, so as to affect the mouth. On the 
last occasion I told him, that, although I 
had relieved his symptoms on former occa- 
sions, it appeared to me that I had not 
effectually attacked the root of the disease, 
and that, as his attacks were always excited 
by cold (for aught I knew to the con- 



195 



trary), the very medicine I had given him 
might render him susceptible of these re- 
lapses ; that, if he would steadily perse- 
vere, I would try to relieve him without 
any mercury at all ; that success would be 
doubtful, and that there would be no chance 
of it unless he agreed implicitly to follow 
my directions. I then put him on a very 
cautious diet. He had been accustomed to 
drink three pints of porter daily, but no 
spirits. This 1 gradually diminished to half a 
pint ; I paid particular attention to his 
bowels, and to his skin, so far as to make 
him wear very warm clothing, and not to 
use the organ more than actual necessity 
obliged him to do; as, in taking his meals, 
or his exercise. 

During the first three weeks, there was 
no perceptible improvement in the eye, al- 
though his own report was that he was 
better. In about seven weeks, however, he 
was perfectly well. Here was a state of eye 
not only threatening organic changes, but 
one in which mercury is known to be es- 
pecially beneficial, and yet it was relie\ ed 
without his taking a grain of that mineral, 

o 2 



196 



or any other medicine but aperients, and 
those of a mild class. Can any one doubt 
that this man will be a great gainer? although 
the proof will probably be negative, and 
shewn in my not seeing him again. But if 
he is again attacked, will not the discovery 
he has made be in all probability of still 
more value to him? Every body knows how 
exceedingly irregular some Dispensary pa- 
tients are in their attendance ; and I have 
often obtained very valuable information in 
this way, either by discerning Nature's pro- 
cesses when left by accident more to them- 
selves than we are accustomed to leave 
them; or, on the contrary, the surprising 
effects of treatment directed to the general 
health, instituted with a view of preparing 
patients for the more auspicious employ- 
ment of those remedies which our present 
experience adjudges to be best for the re- 
spective complaints. I could illustrate this 
by facts which alone would make a small 
volume; but, at the risk of again digressing, 
I will relate two. 

Some years ago, a lady brought to me 
her sister, who laboured under a variety of 



197 



symptoms ; the more prominent of vvliicli 
were, irregular and deficient catamenia, pain 
in the head, fitful appetite, costive bowels, 
cold extremities, and continuous emaciation. 
The quantity of her food had been greatly 
increased, and, to meet an habitual craving, 
that came on at uncertain intervals, she was 
desired, by a physician in very large practice, 
to take biscuits to bed at night. She had 
had a great deal of advice, and I felt very 
diffident about the case, having then had but 
little experience; and the more so, as there 
was nothing surgical In it. I very frankly 
expressed these feelings; and, also, my re- 
spectful dissent from the treatment which 
so distinguished an individual had employed, 
as far as reo:arded the dio:estive oroans. 
That I thought the various remedies which 
she had taken to restore the periodical secre- 
tions, which I believed to be very proper for 
that purpose, could hardly be said to have 
had a fair trial, with such a condition of 
digestive organs. That, therefore, I should 
recommend the renewed trial of these, when 
the state of the stomach and bowels should 
have become improved. To effect this object. 



198 



I recommended mild, but efficient aperients ; 
great warmth to the skin generally, and the 
feet in particular ; and a very moderate 
quantity of plain food, three times a day. 
Care was taken to keep the bowels regular, 
and not to give aperients unnecessarily. 
She was also enjoined to take exercise. She 
followed this advice ; but she soon im- 
proved so rapidly, that I relinquished all 
idea of employing emmenagogues ; which, 
from the evidence of partial circulation, co- 
existing with amenorrhoea, seemed to be the 
proper remedies, and which had been before 
unsuccessfully employed. 

Recently, a gentleman consulted me for 
a very complicated state of ailments, which 
he regarded as the consequences of a gonor- 
rhoea, which is the only one other case I will 
now mention in connexion with this point. 
He had a slight discharge, a small, sinuous, 
sore in the groin, the remains of a sup- 
purating gland of some months' duration. 
He had pains in his limbs, with some 
difficulty and " burning" in making water ; 
tongue furred; bowels open, but not without 
medicine ; appetite moderate. He was a very 



199 



fine young manjbut looked pasty and ill ; and, 
although he had walked but a short distance 
in coming to my house, and said he did not 
feel nervous; yet his pulse was exceedingly 
hurried. His idea was that he had stricture; 
which I told him was not unlikely, but that 
his health was evidently so disordered, that 
it would be injudicious to treat his mere 
local maladies, until his health could be 
somewhat restored. This was accomplished 
by a precise diet, more accurate attention to 
his secretions, and by the subsequent habitual 
use, for a short time, of a tonic aperient. 
Those measures which I had intended at one 
time to adopt, for the relief of his local mala- 
dies, all proved unnecessary. The erysipelas 
subsided first, next the urinary disorder, and 
subsequently the sinuous sore in the groin 
healed. I could relate many analogous cases ; 
but it is unnecessary. But to return to the 
consideration of mercury. Can any one 
doubt that it is of the first consequence not to 
employ this remedy unnecessarily? I sup- 
pose not. It is well known to be occasionally 
productive of bad consequences ; but it is 
not so generally admitted, that mercury will 



200 



occasion complaints not distinguishable from 
syphilis, and which are often treated as such 
by the administration of the very remedy 
which produced them. This has been long 
suggested by some surgeons, but the proofs 
of it have been held as insufficient : because 
they have occurred in persons who have 
had syphilis; or, what equally obscures the 
reasoning, in persons who have had ulcers, 
the nature of which had not been ascer- 
tained; and further, it has been said, that if 
mercury did so produce such disorders, we 
should have these effects occur from it when 
employed for other diseases. This might, 
were it necessary, have been partially an- 
swered by the well-known fact, that mer- 
cury is administered under circumstances 
of much less caution when exhibited for 
syphilis, than when given for more serious, 
or rather more acute affections. In syphilis, 
one patient takes unnecessarily large doses, 
under the influence of apprehension; an- 
other, scarcely altering his mode of living in 
anyway ; and a third, following the directions 
of some ignorant empiric. On the contrary, in 
serious inflammatory affections, persons are 



201 



generally confined to the house; they arc 
kept in an equal temperature; their living 
is, for the most part, necessarily characterized 
by considerable restriction. To all this it may 
be added, that the extreme employment of 
mercury for inflammatory affections is com- 
paratively a recent practice. But whatever 
might have been heretofore said in answer to 
those who oppose the opinion that mercury 
will produce the diseases in question, it is in 
my view no longer necessary ; for I have met, 
within the last twelve years, with many cases 
where patients have had no syphilitic com- 
plaints whatever ; but who, nevertheless, 
had taken mercury for other maladies. It is 
now, certainly, not less than ten years ago, 
that I mentioned, at the Med. and Phil. 
Society of St. Bartholomew's, that I had then 
under my care (as it happened) no less than 
six cases of patients with diseased bone and 
other symptoms not distinguishable from 
syphilis, who declared that they had had 
no venereal affection ; and whose veracity 
seemed to challenge confidence, from their 
saying that they had been severely salivated ; 
some for diseases ol* the eye, and some lor 



202 



affections of the liver. In reply to some 
questions from my friend Mr. Langstaff, I 
stated that it would give me much pleasure 
to shew the cases to any gentleman who 
might feel desirous of investigating them ; 
and probably some who may read these re- 
marks, will remember the fact and the cases. 
I have never, indeed, since had so many at 
one time; but I have been seldom long with- 
out at least one in connexion with this 
subject; forming a class of cases which are 
not only very tractable, but which seem 
to me to owe their cure to constitutional 
treatment. I will give an example or two; 
but will not further anticipate what I am 
desirous of contributing (if I can confine it 
within proper bounds) in the form of a 
paper to the Roy. Med. and Chir. Trans. 
Different cases illustrate different points : 
the following was to me very impressive. 

A gentleman applied to me about the 
latter end of the year 1828, in consequence 
of the following symptoms, which he said 
had not only resisted every measure insti- 
tuted for their relief, but that he was growing 
worse and worse : and that, in addition to his 



•203 



other calamities, the irrcgidarity occasioned 
by his illness in the execution of the duties 
of a public appointment, threatened shortly 
to deprive him of his means of support. He 
was brought to me by his brother, who, in a 
private interview, said that the family were 
desirous of knowing my opinion as to 
whether any thing could be done ; but that 
this step was taken more as a satisfaction to 
their future feelings, than from any hope 
that the case was susceptible of cure or 
amelioration. When I saw the patient, 
nothing certainly could be more deplorable 
than his appearance. He was greatly 
emaciated; he looked pale and exsanguous, 
and his respiration (and, as I thought, his 
skin too) exhaled a most unpleasant odour. 
He spoke like a man whose throat had 
suffered, and was still suffering, from ulcera- 
tion; and several sores were present about 
the margins and inner surfaces of his lips 
and mouth. These had been preceded by 
other ulcers, which had healed, and their 
cicatrices had so pursed up the mouth, that, 
when I desired him to let me see his tongue, 
he could exj)ose but a small portion of it. 



•204 



The same state of ])arts prevented me from 
obtaining a satisfactory view of his throat. 
He had great pains in his limbs, especially 
at night; scarcely got any sleep. His ap- 
petite was irregular and deficient, and his 
bowels also: the secretions from them, as 
I afterwards found, were unhealthy, and 
offensive to the last degree. He had a very 
large sloughing sore near the outer ankle, 
which had been preceded by great pain, 
and now presented a very unhealthy surface ; 
partly ulcerative, and partly sloughing, and 
discharging a very fetid and acrimonious 
ichor : it was also exceedingly painful. His 
circulation was hurried and irregular; the 
pulse being soft, frequent, and feeble. Al- 
together his appearance was so wretched, 
and his constitution so broken, that I cer- 
tainly thought he could never recover. 

So familiar had I become, at that time, 
with the effects of mercury, that, on my first 
seeing him, I pronounced at once that he 
had taken large quantities of mercury ; but 
this he resolutely denied. I then said, you 
must then have had syphilis; but he also 
affirmed as strongly, that he had never been 



205 



affected by any thing of tlie kind : lie Iiad 
some confused recollection of havino; had, a 
great many years ago, a small discharge from 
his urethra, but not any thing which re(|uired 
particular treatment or attention. I told 
him at once, tliat I did not understand his 
case ; that I had seen indiyiduals labouring 
under symptoms so similiar in all essential 
points, y.^iich were clearly the result of mer- 
cury, that I felt myself justified in imputing 
his to the same cause ; that his not haying 
had syphilis did not surprise me, as that 
only further confirmed my cony ict ions with 
ren-ard to such cases; but that his not hayino; 
taken mercury, rendered his complaint to 
me inexplicable : that, therefore, all I 
could say was, that being certain that yery 
similar symptoms were frequently caused by 
that mineral, and that they were perfectly 
relieyed in most cases by a treatment which 
I recommended, I knew nothing better than 
to recommend its adoption to him. I further 
stated, that yery similar conditions of system 
were sometimes produced by yery dissimilar 
causes, and that might possibly be the ex- 



206 



planation of his case* ; that I did not 
pretend to understand it ; but that I knew 
of nothing better than attention to his ge- 
neral health ; a course of medicine such as 
I would prescribe, and the avoidance of any 
thing in the shape of mercury. 

I shall not soon forget the perplexity I 
felt from this case. I had long thought 
that I knew the cases resulting from the 
abuse of mercury; and to find myself appa- 
rently deceived in what I should certainly 
have called a well-marked example, was a 
source of great annoyance. Impressed with 
this feeling, I had allowed him to tell me 
that he had taken large quantities of De 
Velno's Vegetable Syrup, during a period, 
with irregular intervals, of about two years, 
without it ever occurring to me of what 
this nostrum is composed : but relating my 
chagrin to a medical friend, he immediately 
suggested its composition (believed to be 
oxymuriate of merciny in some mucilaginous 
menstruum), when the difficulty vanished. I 

* I have since met with a case which confirms this view. 



207 



now set about attending the case witli better" 
heart, and in about six weeks had the great 
satisfaction of seeing my patient, — to the 
astonishment of his family, and, I wilhngly 
add, my own, — perfectly recovered. I began, 
first, by prohibiting wine and spirits alto- 
gether ; in small portions of which, diluted 
with water, he had hitherto indulged. His 
bowels were freely evacuated by jalap, ipe- 
cacuanha, and ginger, and he took small 
doses of manna and senna in bitter infu- 
sions, to keep them acting regularly. Never- 
theless, as the secretions were exceedingly 
fetid and unhealthy, the powders were oc- 
casionally repeated, and he took camphor 
and opium at night to procure sleep. This 
was subsequently changed for conium and 
hyoscyamus, and the narcotic, by degrees, 
relinquished altogether. The narcotics, 
however, did him little service, until his 
secretions were improved; and then I soon 
found that they were unnecessary. His diet 
consisted of milk, eggs, ground rice, pota- 
toes, arrow root, sago, and tapioca. His meals 
were moderate in quantity, and taken at 
periods of about five hours. He took the 



208 



fluid extract of sarsaparilla in the propor- 
tion of a dessert spoonful to about three 
parts of a half-pint tumbler of water, three 
times a day. He had a common gargle of 
infus. rosae for his throat, and the sore in 
the leg was poulticed night and morning, 
and previously washed with a weak solution 
of nitric acid. In about seven weeks he 
was quite recovered from all his ailments, 
except that his strength was not quite re- 
stored. Some difficulty, I recollect, oc- 
curred in the management of his bowels ; 
but the case did well in the time men- 
tioned, and I now occasionally see him 
walking about strong and well. 

The following is another case, bearing 
on the same subject. A man, being out of 
health, but having no local complaint but a 
boil, applied to a physician, who ordered him 
some aperient medicine, and the compound 
calomel pill. Having, as it appeared, rather 
an unusual susceptibility to mercury, he had 
taken very few of the pills before he found 
himself salivated. In this state he walked 
from Westminster to Hoxton in the rain, 
and got completely drenched to the skin; the 



209 



consequence was, that he became attacked by 
pains in his h'mbs, and sore throat, which, to 
use his own expression, " had several holes 
in it." He now consulted an eminent sur- 
geon, who gave him mercury to salivation 
again ; and (as often happens) with some 
benefit to his throat, which he said got 
much better ; but, as he was not well, he 
relinquished his attendance on the surgeon 
in question, and, after a short interval, ap- 
plied to me. He had still ulcers in his 
throat and pains in his limbs; but as I 
thought the case very clearly the result of 
mercury, or of the agency of cold, applied 
during the time that he had been affected 
by that mineral, I did not think of pre- 
scribing it, although he had a scaly eruption, 
which some would have thought a suspi- 
cious circumstance. Attention to his gene- 
ral health, a milk diet, and abstinence from 
mercury, with the regulation of his secre- 
tions, in about a month restored him to his 
usual health ; and as I have not since heard 
from him, I presume that he has had no 
return of his complaint. Now, nothing 
happened here but that which is common 

p 



210 



enough, viz. inflammation and ulceration 
of the throat, excited by cold, and accom- 
panied by pains in the limbs ; but the sore 
throat presented characters allied to, or 
identical with, those of sj^philis. Now, 
Mr. Abernethy shewed long ago, that ulcers 
simulating syphilis, occurred in other parts 
as well as the throat. When the throat is 
affected, as in the case just referred to, by 
the influence of cold, the common, and, so 
to speak, the comparatively healthy sympa- 
thy, is common inflammation, or, if violent, 
perhaps abcess. But would it have been 
reasonable to have expected, a priori (the 
exciting cause being the same), a specimen 
of healthy sympathy in a system, affected 
by mercury to salivation ? Do we, in fact, 
find healthy inflammation any where else 
when the inflammatory actions have been 
excited during disturbed conditions of the 
system ? Undoubtedly not. Do we not 
rather look for erysipelas, or some other of 
its numerous and undescribed varieties ? 
But the endless varieties in the appearance, 
progress, pain, and other characters, result- 
ing from inflammatory action, connected 



211 



with disordered health, are no where better 
exemphfied than in the common diseases 
of the extremities. 

I would by no means represent these 
cases as the result of mercury acting in 
virtue of any specific property it may pos- 
sess ; that appears to be a hazardous conclu- 
sion ; it seems quite as probable that it may 
operate by that disturbance of the general 
health, which it may have the power of 
producing, in common with many other 
causes. That it may more frequently pro- 
duce disturbance of a given kind than other 
causes, may happen from its powerful effects 
on the body, and from the great extent and 
frequency of its administration. But that 
conditions of the system, not distinguishably 
different from that produced by mercury and 
syphilis, may result from influences of a dif- 
ferent kind, the followino- case (as I lono; a^o 
thought, see page 206) sufficiently evinces. I 
have the notes in full, taken by Mr. Percival 
Leigh, a very zealous and intelligent stu- 
dent ; but a short abstract will convey its 
important features. About fifteen months 
ago, a man applied at the Dispensary with 

j> 2 



212 

a large and deep sloughing ulcer of the 
throat, not distinguishable from those said 
to be syphilitic. He had great pains in 
his limbs, and was exceedingly out of 
health ; his bowels particularly costive, and 
his tongue particularly foul. He had been 
ill already some months, and had been 
under the care of a surgeon, who gave him 
mercury, and who is reported to prescribe 
very little of that mineral in such cases, 
which I mention, because it proves the 
more emphatically that, in his opinion, the 
sore had the syphilitic character. How- 
ever, the man, finding that, on his mouth 
becoming sore, he got no better, but, 
indeed, rather worse, relinquished his at- 
tendance on the surgeon in question, and, 
after remaining a short interval without 
any advice, applied to me. Now it was 
quite certain that the mercury, here, had 
not produced the sore, because the sore 
preceded its administration. When I saw 
him with such a tonpue, I thouo^ht of no- 
thing but endeavouring to improve his ge- 
neral health. The treatment was conducted 
chief!}' by Mr. Leigh, under my superin- 



•213 



tendence; consisting of spare diet, aperients, 
and decoction of sarsaparilla. The throat 
did not mend materially ; but, on the other 
hand, it did not seem to get materially 
worse. Nothing: o^ave us more trouble than 
his bowels, which were pertinaciously cos- 
tive, so as to induce us, at last, to relin- 
quish all remedies except aperients. At 
length we succeeded in procuring numerous 
and free discharges from the bowels, by 
means of aloes and soap, given in large 
doses, three times a day. It was surprising 
to see the effect of this measure ; the throat 
healed rapidly, without further trouble. 
About twelve months after this, that is, 
about two months ago, or hardly as much, 
this man applied again, with a similar affec- 
tion, and with a similar state of system, and 
of bowels especially. Although we had taken 
notes of his case, w^e did not recollect the 
particular circumstances ; and therefore he 
was placed on a plan directed to his general 
health, and the regulation of his secretions. 
We soon found, however, that the same dif- 
ficulty occurred with regard to the bowels ; 
and this recalled to our memories the key 



214 



to his case. On referring to the notes, we 
employed the same aperient as before ; on 
which his throat got better : but he would 
go out, contrary to my orders ; so that, 
partly from his bowels, perhaps, having be- 
come accustomed to the remedy, and partly 
from unfavourable influences on the skin, 
his bowels would not act so regularly as be- 
fore. I now told him, if I found him disobe- 
dient again, I would relinquish my attend- 
ance. I therefore confined him to his room, 
and made him take a vapour bath ; his 
bowels now not only acted more kindly, but 
with a milder remedy, castor oil, which was 
prescribed by Mr. Leigh. His throat now 
began to mend rapidly, and this day (De- 
cember 10), on examining him, I found a 
great part of a large cavity filled up, and 
the whole covered with healthy florid gra- 
nulations. This man's complaint seems, on 
both occasions, to have been excited by 
cold acting on the skin, rendered suscepti- 
ble by its sympathy with disordered bowels. 
In his avocation (an ostler) he is much ex- 
posed to cold late at night, and washing 
liorses' feet, &c. in the day. I have a very 



215 



instructive case now under my care, pro- 
duced by mercury, where tliat mineral has 
been recently administered for a cerebral 
affection, consequent on a shock felt by 
the patient, having his son brought home 
drowned ; but, as I hope to discuss the sub- 
ject of mercury in a distinct paper, for the 
present I will content myself with the 
announcement of the fact, that mercury 
does unequivocally produce diseases which, 
from mistaken views, are again treated by 
mercury ; and in cases where there is no 
evidence of there having been any syphi- 
litic affection, much less where it has been 
administered for that complaint, but in 
cases where it has been administered for 
other diseases. The unnecessary employ- 
ment of powerful remedies has been, in my 
experience, more frequently exemplified by 
mercury, because it is more likely, perhaps, 
than other remedies, to fall within the sur- 
geon's observation ; but I am far from be- 
lieving that the remark applies only to that 
mineral. 

On the contrary, I believe many other 
remedies are occasionally re-sorted to, — I 



216 



will not say in cases where they may not 
be capable of affording relief, but where 
they are as yet unnecessary. All this may 
seem more the province of the physician 
than the surgeon ; and certainly the mul- 
tiplicity of objects demanding the atten- 
tion of the surgeon, might well excuse him 
from extending his views beyond them : 
but, in the present state of science, a man 
must become a medical surgeon, or no sur- 
geon at all. The well-established depend- 
ance of surgical diseases on varying states 
of the constitution, no longer allows it to 
be considered as a debateable question. 
The catalogue of local maladies is every 
day diminishing, and the question is daily 
taking another form; being not whether 
local diseases do, or do not, depend on con- 
stitutional causes ; so much as, which is the 
most enlarged and best mode of directing 
the constitutional treatment of them ? As, 
in this question, no single organ is of more 
importance than the stomach, hence that 
viscus becomes necessarily one of the prin- 
cipal points of study, and this gives the 
surgeon the deepest interest in every thing 



217 



appertaining to tlie eflects produced on it^ 
either by food or medicine. So far, there- 
fore, from having any wish to travel into 
another branch of science, I always feel 
that, in considering the stomach, I am but 
cultivating one of the most difficult and 
important points of my own profession ; 
and, if I mistake not, before science can be 
materially improved, instead of talking of 
divisions in the profession, there must be 
a much closer intermixture of the study of 
surgery by the physician, and of medicine 
by the surgeon, than we are at present 
accustomed to think necessary. 

The following case appears to me in- 
teresting ; and the more, from this cir- 
cumstance : — that I met the gentleman a 
few days since, and said that I intended 
to mention his case as a good illustration 
of what might be done by attention to the 
functions of the stomach, and as one which, 
had it been so relieved, would have been 
put down, at the respective periods, as a 
successful example of the effects of prussic 
acid and kreosote ; when, for the first time, 
he informed me that he had taken both 



218 



those remedies, without benefit. About 
five years ago, a medical friend of mine, 
about forty years of age, having taken mer- 
cury, under my advice, for a threatening 
amaurotic condition of the eye, and being 
recovered from that, complained of weak- 
ness and sinking about his stomach, and 
occasional irritation in the organ. He was 
recommended to be careful in his diet, and 
to attend to his secretions. He said, at the 
time, he had been recommended prussic 
acid, or at least so I understood him ; but 
it appears now that he had already taken 
it without benefit. I recollect dissuading 
him from it, and stating, that as he had 
always been subject to attacks of disordered 
biliary secretion, and irritable stomach, it 
was likely he was suffering from the mer- 
cury ; but, as that cause had now ceased, 
that, with the cautions I would recommend, 
he would soon recover. I added, you must 
admit that prussic acid is not a negative 
remedy ; that, if it be not necessary, it 
must be likely to be prejudicial ; and if it 
be necessary, said I, just think what state 
of stomach that must be, to require prussic 



219 



acid to put it right. Well, the arguments 
which I had intended to prevent him from 
taking the prussic acid, probably served to 
make him rehnquish it. Be that as it may, 
he got perfectly well, by attention to his diet 
and bowels, and that in a very short time. 

The same gentleman was attacked, last 
year, with symptoms of a more serious 
character, and, as I think, beginning in dis- 
order of his liver ; but this was not to be 
made out clearly. He had considerable 
pain some little time after he had taken 
food ; and this became pretty constant. 
Subsequently, it was followed by vomiting 
about two hours after he had eaten ; and 
this had led him to consult me ; the vomit- 
ing having occurred in the previous four 
days in succession. I heard nothing of 
kreosote ; but it appears, by what he has 
recently informed me, that he had already 
taken it. I felt very much interested in 
the case. I was therefore earnest in my 
endeavours to impress him with the im- 
portance of attending to my directions. I 
said it is plain that your stomach will do 
very little ; and therefore the first thing is 



220 



to give it very little to do. Further, this 
little should be given in very small quan- 
tities at a time ; and, if it be necessary, in 
order to get the nourishment required, to 
take it at five or six times in the day ; add- 
ing, this is far less an evil than putting more 
at any one time into the stomach than it is 
capable of digesting. He accordingly very 
steadfastly adhered to this plan ; the quan- 
tity of food taken at any one time being 
very small, and consisting of dry toast, 
bread pudding, and weak broth with bread ; 
but avoiding any considerable quantity of 
fluid of any kind. This was on Monday. 
On the following Thursday, he was so much 
better, as to be really very comfortable ; 
and asked my advice about the propriety of 
eating a mutton chop. I told him I thought 
it involved a risk, which, in so early a stage 
of his treatment, it would be imprudent to 
incur ; nevertheless, on Saturday, he ate 
the mutton chop. On Sunday morning, 
I was sent for from the country, with a 
message saying he was very ill. When I 
arrived in town, I found that he had Dr. 
Campbell, of Duke Street, and Mr. Wilson, 



221 



of Northampton Square, with him ; tliat 
they had been sent for in the niglit ; tliat 
they found our patient in great suffering, 
and that he was labouring under a severe 
attack of gastritis ; that tliey had applied 
leeches largely, and a blister. He was now 
much better, free from pain, but felt very 
weak ; his pulse, however, was very soft ; 
his tongue white, but moist ; and his skin 
comfortable, and in rather profuse perspira- 
tion. I had, of course, nothing to say, but 
to desire him to resume his former plan, 
and, for the present, with still greater re- 
strictions as to quantity. He took diapho- 
retics, with a view to the sympathy between 
skin and stomach, and occasional mild doses 
of calomel, to promote biliary secretion. 
In a very short time, about ten days, he 
got perfectly well, with no other remedies, 
except a little infusion of gentian, which I 
really forget whether he took or not, but 
which he had Dr. Campbell's and my own 
permission to do. 

I have recently seen reported, in the 
public journals, a case of gastrodynia, as it 
is called, treated by kreosote, wherein, how- 



222 



ever, the remedy was not, as it appeared, 
entirely successful, but at the same time 
exhibited in large doses with considerable 
benefit. The case, however, in question is 
one which 1 have seen, over and over again, 
reheved by attention to the functions of the 
stomach, and a particularly well-marked one, 
of one form of indigestion. The report 
stated that the woman complained of pain 
always after she had eaten ; but there was 
reason to believe that when the stomach was 
empty she was perfectly easy. I know that, 
ip many cases, relief can be obtained by 
various stimuli, and especially by brandy : 
but I can neither approve of the brandy nor 
the kreosote ; because I am certain that they 
are both often unnecessary, and that at least 
the former proves injurious. 

Before I quit the subject of attention to 
Sympathy, as enlarging the constitutional 
treatment of local diseases, I wish to add a 
few remarks with reference to the influence, 
which I trust it will be found to have in ex- 
pediting the successful treatment of diseases 
of joints; numbers of which are annually 
amputated, as I verily believe, without ne- 



223 



cessity. I have seen a great number of cases 
of diseased joints, — those who know how 
I have been situated are well aware it must 
be so; but it is comparatively seldom that 
I have had occasion to amj)utate a limb ; and 
where I have been so obliged, it has never 
been but for one reason ; viz. that the local 
disease was so seriously disturbing the pa- 
tient's health, that I could not persevere in 
my efforts for preserving the limb, without 
endangering life. Comparatively few as those 
cases have been, I believe that, had I always 
known that which I now do, their number 
would have been further diminished. I can- 
not say, of course, what has been the precise 
pathological condition in different cases, 
because nothing but dissection could ab- 
solutely prove it ; but there are no af- 
fections of joints (malignant diseases ex- 
cepted), no matter in what structure they 
may commence, or how many they may 
ultimately involve, which it is not my firm 
persuasion are well within the reach of treat- 
ment, and in the vast majority of cases : 
whilst not a year passes, that I do not 
see more or less examples of amputations, 



224 



wherein I should not even begin to think of 
such an operation. Surely, if this be the case, 
and I have recently had the satisfaction of 
finding that my experience is by no means 
singular, many joints may be saved which 
we are now under the humiliating necessity 
of removing — as I can illustrate with refer- 
ence even to cases wherein I have myself 
recommended the amputation of the limb. 

There are two especially which made a very 
deep impression on me. Both the cases in 
question were seen — the one by Mr. Lang- 
stafF and Mr. Kingdon, the other by the 
latter gentleman. The first case was that of 
an individual residing at Pentonville, about 
fifty years of age, who had pain and inflam- 
mation in his knee, of some months' standing. 
Matter had formed, and several apertures 
led down, as I supposed, to diseased bone ; 
but I did not examine it by the probe, as 
the ascertainment of the fact does not, in 
one case in a hundred, alter the treatment, 
whilst the smallest irritation should be 
avoided. That the bone, however, was af- 
fected, was subsequently proved by several 
portions being thrown off by exfoliation, 



•225 



and, as it appeared, chiefly from the end of 
the femur. His diet and general healtli were 
particularly attended to, and the knee kept in 
splints. However, he occasionally had con- 
siderable pain; and this; operating, as I have 
since had reason to believe, in conjunction 
with moral causes, impaired his general 
health so seriously, that I felt myself at length 
reluctantly obliged to propose the removal 
of the limb. It was on this occasion that Mr, 
Langstaff and Mr. Kingdon saw him, and 
that they coincided in my views. The man, 
however, stated that he thought his health 
so reduced, that the shock of the operation 
would be too great for him, and that, al- 
though ready to submit to any plan I pro- 
posed, he would not have his limb removed 
vmless I could speak with considerable con- 
fidence on that point. I told him all I knew 
with regard to similar cases; that, in fact, 
where the health was sometimes most seri- 
ously affected, the removal of the local ma- 
lady proved most beneficial : that patients 
rose buoyant and soon recovered ; that if the 
limb w^ere my own, I would not for a moment 
hesitate in having it removed; that, at the 



226 



same time, the good effects of which I then 
spoke were not invariable; and that, to speak 
with the confidence which he required, as to 
the result of an individual case, was impos- 
sible; but all I could say, was, that I verily 
believed that he would do perfectly well. 
The little reservation which I felt it neces- 
sary in sincerity to make, determined him 
against the operation ; and, being fully satis- 
fied of his determination to keep his limb, 
I accordingly renewed my attention, I need 
not say how anxiously ; and although the case 
was wavering and tedious, yet ultimately he 
got perfectly well. His joint was anchylosed 
of course ; but it was straight and useful. The 
other case to which I have alluded, was of 
a different kind. A woman, about thirty, 
sent for me on account of a diseased knee; 
and, when I saw it, I thought of nothing but 
amputation. The history and appearance of 
the joint was that of a scropliulous affection ; 
her health was very much impaired; there 
was evident effiision into the joint, and con- 
siderable enlargement of the head of the 
tibia and condyles of the femur; and the 
destructive processes appeared to have so 



227 



destroyed, or softened the restraining tex- 
tures of the joint, that the femur and tibia 
were far from being in correct apposition, 
the former appearing to be on the inner 
side ; I proposed a consultation to deter- 
mine the question, whether I should ampu- 
tate the limb at once, or whether it would 
not be better to endeavour to improve the 
health a little, at all events, before I re- 
moved the limb. Mr. Kingdon supported me 
in the latter view, but had no idea whatever 
that the limb could be saved; neither had I, 
although it did so happen, that on leaving 
the house, I carelessly said, " and if her 
health gets better, perhaps some favour- 
able change may take place in the limb, and 
we may save it after all." Now this woman 
got perfectly well, under a treatment whicli 
combined great attention to her diet, her 
secretions, and keeping the part absolutely 
motionless by splints — so much insisted on 
by Mr. Abernethy. I have seen many cases 
tending to the same point; but these particu- 
larly struck me, because I liad in both re- 
commended amputation myself Now I 
cannot say that, in either of these cases, the 

Q 2 



228 



success turned on a specific appeal to any 
particular sympathy, because in neither case 
was that difficulty presented which required 
it ; but T mean to observe, that I treat every 
case with a constant attention to the sym- 
pathies, and, in my endeavours to put any 
particular organ right, am constantly watch- 
ino' the conditions of oroans with which 
that one may sympathize, and ministering 
to their functions where they evince faihu'e, 
in some way or other, in order that they 
may not impede the restoration of the 
primary organ by their sympathy, if they do 
not promote it: but I mention these things 
more, because a sedulous attention to them 
may render the restoration of diseased joints 
quicker^ than because the cases are difficult; 
but, the processes in the parts affected being 
necessarily slow, it is to be feared that the 
duration of the task sometimes engenders a 
despair of its execution ; and that if we could 
quicken the processes ever so little, the prac- 
tice of saving joints might be more general. 
As I know of no mode of doing this, but 
by restoring the general health, and keeping 
the part quiet, so I know of no other mode 



229 



of accelerating the former ol^ject than a 
sedulous observation and careful attention to 
those organs which are ahke important, on 
account of their respective functions, and 
of their sympathetic connexion with eacli 
other ; I mean particularly the mind, the 
nervous system, the skin and respiratory 
organs, the chylopoietic viscera, and the 
kidney. 

In concluding my remarks on this im- 
portant and difficult subject, let me guard 
myself from appearing to favour that prac- 
tice, which is characterized by a mere minis- 
tering to symptoms ; than which, I believe, 
nothing is more prejudicial or short-sighted, 
whilst it has the additional objection, of usu- 
ally operating to the exclusion of measures of 
more real and permanent benefit. If some of 
my readers are surprised at a remark occa- 
sionally let fall with regard to the present 
practice, I need only ask them to consult 
the various periodicals, and they will pro- 
bably find that the observation has not been 
made without reason. In surgery we have 
very striking proofs of the disadvantage 



•230 



of directing our measures too exclusively 
to a particular symptom, because it may 
be the more prominent. In the occa- 
sional repercussion, as it is called, of cuta- 
neous diseases, and on the healing of certain 
ulcers by means which minister mechani- 
cally to the vessels of the part, if this be 
accomplished without attending to the state 
of the constitution^ every one knows that it 
is frequently followed by affections of some 
important organs, which in some cases have 
preceded the local affection ; so beautifully 
do the law^s of Nature teach us, if w^e would 
but attentively observe them. The man 
who is a confirmed dram-drinker, and he, 
who convinced of its deplorable tendency, 
resolves gradually to wean himself of a per- 
nicious habit, both direct their actions to 
the same organ ; so does he who takes the 
alkali to correct the acid ; and he, who by 
an enduring self-denial, determines to avoid 
those articles of food on which the form- 
ation of the acid may depend ; they both 
may be said to minister to symptoms, — but 
I need scarcely say in how different a 
manner. 



231 



In treating by tlie sympathies, it is not 
meant that the greatest attention shonld 
not be paid to the organs primcmly affected ; 
but when, if, from any of the causes men- 
tioned, our measures prove unsuccessful, then 
appeals may be made to other organs ; and 
first to those which evince sympathy with 
the primarily affected organ^ ; but if, so far 
as we can judge at least, an organ does not 
appear to sympathize at the time, still, 
if it be known to have an established ex- 
citable sympathy with that which is pri- 
marily affected, as the stomach and liver, 
liver and bowels, or these with the skin and 
kidney, although such organs may evince no 
disorder, still effects on them will often pro- 
duce markedly beneficial results on the 
primary organ. During these attempts, the 

* I should observe, that sometimes an organ may be 
very markedly sympathizing, but the patient's attention will 
not be drawn towards it, in consequence of the more pro- 
minent affection of some other organ. In this way I have 
often repeatedly asked a patient if he had any other symptom 
of which he complained ; and being answered in the nega- 
tive, immediately detected others by questions directed to 
the sympathies of particular organs. 



•232 



treatment of the primary organ should be 
negative, as it were ; that is, confined to 
avoiding any injurious impression. It is 
very interesting to see how Mr. Abernethy 
was led to this, when the organ primarily 
affected was one, our means of influencing 
which are limited ; and of which his 
clear perception led him (in considering the 
effects of the stomach or the digestive 
organs) to say, that, in administering to the 
nervous system, we can at least take care 
that it receive no additional disturbance 
from organs so wont to disturb it as the chy- 
lopoietic viscera. I hope I have said enough 
to prevent misconception of my meaning, 
or to be understood, while I am pleading 
for more enlarged views of disease, to in- 
culcate a practice which merely ministers to 
symptoms ; one to which, it would be in vain 
to deny, our total ignorance obliges us occa- 
sionally to fly ; but which, in its most common 
adoption, is every way objectionable; it is 
short-sighted as to the causation of disease, 
it is generally injurious in its remote con- 
sequences, it is the very essence of quackery, 
both regular and irregular, and never, I be- 



233 



lieve, effected three real and sustained im- 
provements from the days of Hippocrates to 
the present time ; whilst, by supplying the 
place of more enlarged views, and especially 
those which should constantly regard relief, 
or rest from the functions, of the disordered 
organ, as the great fundamental principle 
on which its permanent tranquillity is to be 
established ; it is not only a bar to improve- 
ment, but is constantly casting the shadowy 
veil of empiricism over the operations of 
Nature. 



The following discourse, of which a few copies were 
published last year, chieflj for the purpose of private circu- 
lation, having been favorably received, I have been em- 
boldened to put it now in a more public form ; the more, as 
it is, in its essential parts, but a continuation of the argument 
in favour of the constitutional treatment of local diseases. 
As I could not add to its force without enlarging the volume, 
and materially altering its whole structure, I have ventured 
to allow it to preserve the form in which it was delivered ; 
and not without the hope that the preceding remarks on sym- 
pathy, and the discourse, may mutually support each other. 
The reader will readily for himself separate the argument, 
and the endeavour to correct some misapprehensions which 
exist with regard to the opinions of Mr. Abernethy, from the 
less essential parts of the Lecture ; which, I may add, was 
Introductory to some Lectures on Clinical Surgery. 



" Hujus enim facta, illius dicta laudantur." 

CiC. de Amicit. 



Gentlemen, 

The subjects most appropriate 
for the introduction of Surgical Lectures, 
whether Chnical or Systematic, have been 



235 



so frequently and so ably discussed, that an 
introductory lecture has become a task at 
least somewhat embarrassing. Truths, how- 
ever important, when often repeated, appear 
trite and uninteresting, unless invested with 
some novelty of colouring or position ; if 
this be not impracticable, it is certainly 
difficult, as there seem scarcely any which 
tortured ingenuity has not already fore- 
stalled. 

The history and progress of our art, in 
all its interesting detail ; the commanding- 
usefulness, which justly places it so high in 
the scale of human knowledge ; the exalt- 
ing nature of its various studies, in the im- 
pressive recognition which they constantly 
afford, of boundless wisdom, goodness, and 
power ; the dignified and deep responsi- 
bility of its several duties, and the moral 
beauty of the kindly affections which they 
are calculated to engender, have been re- 
peatedly described and largely expatiated 
on, with all the interest and ornament which 
learning and eloquence could command. 
If a Lecturer would view the subjects usu- 
allv selected on such occasions as common 



236 



property, ^i^d treat them in his own man- 
ner, he must be vain indeed if he fear not 
the disparagement consequent on a busy 
comparison with some more distinguished 
predecessor. Introductory Lectures, how- 
ever, if not required by necessity, are at 
least strongly suggested by custom ; I shall 
therefore preface the Clinical Lectures 
which I am about to deliver at this Dis- 
pensary, by a few preliminary observations. 
For the reasons implied in the foregoing 
remarks, I shall, as much as possible, avoid 
the path so frequently trodden on such oc- 
casions, and make the present address sub- 
servient to the general business of the 
Course. About to be fellow travellers, as 
it were, I would unfold to you at least a 
portion of the map of our intended journey, 
— point out to you the general bearings of 
the course I propose to take, — and offer 
such suggestions on the mode of proceed- 
ing, and the guides we should chiefly regard, 
as seem best calculated to prevent your 
passing, unnoticed, any thing which is really 
worthy of observation. Leaving metaphor, 
I would present you with at least a general 



•237 



view of tlie kind of surgery wliich it is my 
object to teach ; the principles on wliich it 
is based, and the individuals to whom we 
are mainly indebted for them. 

If, Gentlemen, we take a retrospect of 
the history of Surgery, we scarcely recognize 
it as a science previous to the time of the 
Hunters and Baron Haller. Before their 
time, it was an useful art certainly ; and 
althouoh it mioht have ao't^ravated some of 
the maladies which it was intended to re- 
lieve, still, on the whole, it effected a con- 
siderable diminution of human misery ; but 
it scarcely deserved the name of a science. 
I will not say that there were no obscure 
evidences of a dawning existence ; but it 
was chaotic ; without form ; and void of 
any order, which could afford a resting 
place for the eye of Reason, whence she 
could contemplate the various masses which 
surrounded her ; much less was there any 
light to facilitate the arrangement of the 
several objects, so as to render them avail- 
able portions of human knowledge. It 
appears to me, to have been reserved for 
the genius of John Hunter, to sui)ply the 



238 



light desired — to penetrate the dark void— 
and to elicit those splendid results, which, 
whilst they have perpetuated his name in 
the recollections of an enlightened and 
grateful posterity, have rendered medical 
science, of all others, the most useful in 
diminishing the sum of human calamity, 
and have stamped it as such, with the im- 
press of his own immortality. 

We cannot, indeed, be insensible to the 
merits of his highly gifted contemporary, 
Baron Haller. We cannot be unmindful 
of the extraordinary example which he af- 
forded, of that mass of information which 
may be accumulated by a single individual, 
of his voluminous writings, nor of his ac- 
quirements in almost every branch of hu- 
man knowledge — which severally claim our 
respect, admiration, and gratitude. Dr. 
William Hunter, also, is entitled to no 
small share of our regard ; for, to him we 
are, doubtless, indebted for first fostering 
his brother's rising genius ; for supplying 
him with the means for its cultivation, and, 
not improbably, with those necessary for 
his support, — anxiety concerning which. 



289 



will too often obtrude itself on tlie as- 
pirations of genius ; and under whose wi- 
thering influences it has not unfrequently 
perished or decayed. The Museum of Dr. 
William Hunter*, whilst it constitutes his 
best eulogium, shews how invaluable an 
assistant he must have been to the early 
efforts of his distinguished brother, to whom 
we are mainly indebted for first broach- 
ing those principles on which our present 
surgery is based. 

Before the time of John Hunter (not- 
withstanding the important discovery of the 
circulation), a knowledge of Surgery might 
be said to have consisted in the recollection 
of a vast number of facts, of which neither 
the real importance nor true connexion was 
at all understood. No idea seems to have 
been entertained of that comprehensive ge- 
neralization of the multitude of dissimilar 
occurrences, constituting the phenomena of 
disease, which now refers them, for the 
most part, to a few known laws, or to a lew 
physio-pathological principles, legitimately 



* Now lit Glasgow. 



240 



deducible from them. The qualifications 
which were thought chiefly essential in the 
Surgeon, appear to have been little more 
than a good eye, a steady hand, a retentive 
memory, — with some opportunities for ex- 
ercising them. We find a great deal said 
with regard to the physical qualities ; of 
the manus, strenua, stabilis, nec unquam 
intremiscens ; but when the head was to be 
consulted, when any thing beyond the reach 
of the external senses was to be considered, 
we are reminded of the necessity for a phy- 
sician. It had not been discovered, that 
a knowledge of the animal economy was 
equally necessary to the physician and sur- 
geon ; still less had it been conceived, that 
the study of surgery not only affords the 
clearest evidences, but is almost the only 
mode, by which we can approach any thing 
like demonstration of the laws of vital ac- 
tion, or by which we can apply them to the 
explanation or removal of diseases. 

The character of John Hunter has been 
so often drawn, that it has become familiar 
to most of us ; hence only a few remarks 
will here be necessary. He seems to have 



•241 



been born with a nuinber of extraordinary 
qualities, which, if they combined not every 
quahfication for scientific investigation, con- 
stituted as near an approach to this order 
of perfection, as we can reasonably expect 
in man. To a mind characterized by a love 
of truth, only equalled by his ardour in the 
pursuit of it, was joined a most clear and 
penetrating perceptive power ; and, to 
crown the whole, the most enduring indus- 
try. There seems to have been scarcely 
any process in animal or vegetable life, to 
which his attention had not been directed : 
and although it is probable, that the Mu- 
seum which he left, stupendous as it is, 
contains but the records of the more im- 
portant subjects which he had investigated ; 
yet probably it is the most remarkable work 
ever achieved by a single individual. To 
say nothing of subjects which it is almost 
certain must have occupied his attention, 
but of which we have no positive proofs, — 
not reckonino; the multiform considerations 
and reflections, leading to, and arising out 
of, the preparations which he has left us ; 
not taking into the account the various un- 
11 



242 



published volumes, which were so unfor- 
tunately destroyed ; but contemplating the 
Museum as we see it, — whether we consider 
it, with reference to the investigations of 
the various processes in animal or vegetable 
life, of which it affords proofs ; the in- 
finitely varied manner in which these are 
unfolded and exemplified in health or dis- 
ease, or even the mere mechanical occupa- 
tion, we at once recognize it as a wonder- 
ful example of human talent and industry. 
When, however, we recollect that the la- 
bour was accomplished in the busy hum of 
a metropolis, amidst various unavoidable 
interruptions from other important avoca- 
tions, with the occasional embarrassments 
of indisposition ; and when, lastly, we re- 
flect that the whole was the effort of an 
individual, whose pecuniary means were 
often painfully restricted, during a compa- 
ratively short life ; language supplies no 
symbol which can adequately designate the 
depth or variety of our sensations, and we 
oaze on the vast fabric with silent admi- 
ration. 

Mr. Hunter, however, shewed that we 



•243 



are not to expect perfection. I would not 
undertake to say, tliat the vigilant caution 
which so constantly presided over his la- 
bours, and which, examined with such 
scrutinizing accuracy the legitimacy of his 
conclusions, might never have slumbered* 
during a life of such exertion : but the point 
to which I wish especially to direct your at- 
tention, was, the limited power which John 
Hunter possessed, of conveying his ideas 
to the minds of others, so as to produce a 
correct translation of his own impressions. 
His power in this way was indisputably re- 
stricted ; and many of the circumstances 
which exemplify this deficiency, at the same 
time convey its explanation. 

A circumstance which adds not a little 
to our admiration of John Hunter's genius, 
is, that he was, comparatively, an unedu- 
cated man ; and with but little variety of 
language at command, stood more in need 

* It has been tliouglit that Mr. Huuter's reasonings on 
Syphilis, are not characterized bj his usual caution. The 
progress of science has changed the grounds on which he 
rested them, certainly ; but they were regar."'ed as determined 
tacts at that time. 



244 



of enlarged powers of expression, than 
most other individuals. His ideas were not 
only remarkable in number, as arising out 
of a great multiplicity of subjects ; but 
many of them were altogether new : so that 
what I have ventured to represent as an 
original defect, was thus painfully increased 
by the very talents which accompanied it. 
John Hunter's works illustrate these re- 
marks. Although we are so impressed with 
the value of the principles and precepts 
which they contain, — as to recognize in 
them the very grammar of medical science ; 
as conveying that which, therefore, cannot 
be learnt too soon ; yet they are scarcely 
adapted to the early studies of the medical 
pupil. It is expedient, before the student 
read the works of John Hunter, that he 
have some idea, from other sources, what it 
is that he is to expect ; he should know his 
teacher a little in theory, before he sits 
down to converse with him in the closet. 
If then the abstract truth and importance 
of Mr. Hunter's physiological and patholo- 
gical opinions, were sufficient to secure 
their establishment as such; still a practical 



245 



application of them, co-extensive vvilli their 
merits, required the operations of a mind 
of a different order. A mind which, to 
coincidence of opinion with John Hunter, 
should join a perception, no less clear and 
penetrating than his ; a mind which should 
be amply stored with enlarged powers of 
expression, and a ready facility of adapting 
them to original ideas ; — which, to assist 
intellects of ordinary or even subordinate 
capacity, should have also the property 
of simplifying difficult subjects, of placing 
them in striking and interesting points of 
view, and of elucidating them by ingenious 
varieties of illustration. A mind which, 
with this sympathy with intellects of com- 
mon calibre, should combine sufficient grasp 
to take enlarged views of subjects, and a 
rapid perception of those points, which 
might be wrought into practical usefulness, 
— whose genius should enable it to build on 
these harmonious structures, the offspring 
of a creative induction ; and, finally, to 
display the whole fabric, so as to convey, 
even to the student, correct ideas of its 



246 



relation and bearing on the practice of 
Surgery. 

For the fulfilment of such desirable ob- 
jects, an individual, especially qualified, 
arose ; and. Gentlemen, I am willing to be- 
lieve, that before I mention it, you will 
have anticipated the illustrious name of 
Abernethy. But lest enthusiasm should 
have wandered from its only safe con- 
ductor, truth, let us examine the foregoing 
sketch, and see if it be overcharged. Could 
an}^ thing surpass Mr. Abernethy's power 
of simplifying difficult subjects, if we ex- 
cept the pleasing and happy manner in 
which he was wont to illustrate them ? 
Where shall we look for that rapidity and 
clearness with which he seized the difficult 
points of a question ; or for that ingenuity 
which enabled him to invest every thing 
with colours, which so often rendered the 
most dry and uninteresting subjects, at 
once instructive and inviting ? and, with 
regard to his powers of expression, where 
shall we find a syle which, though not 
perhaps critically faultless, combined ele- 



247 



gance and perspicuity in more siiccessf'iil 
proportions ? 

Is it not deeply interesting to reflect, 
that those powers, the deficiency of which 
we cannot but lament in Mr. Hunter, should 
have constituted the distinguishing attri- 
butes of Mr. Abernethy ? Could any thing 
have been more fortunate for the interests 
of science, than that chain of events, which 
determined that the individual thus so ex- 
pressly qualified, should become, at once, 
the eloquent expounder, and zealous advo- 
cate of Mr. Hunter's opinions ? Mr. Aber- 
nethy, however, was far from confining 
himself to a simple exposition of Mr. Hun- 
ter's doctrines. He found that the truths 
discovered by Mr. Hunter, not only coin- 
cided with, but often too, explained those 
which he himself had remarked, if not with 
the same labour, still with equal accuracy 
of observation. 

To analyse and connect the various 
opinions of these great men ; to shew 
where they arose out of each other, or 
where, though of independent creation, 
analogous truths illustrate the identity ol' 



248 



their views, would be an employment 
highly interesting, and not uninstructive ; 
but the limits of a lecture prechide any at- 
tempt of the kind ; wherefore I shall con- 
fine myself to those more immediately 
connected with my present objects. 

I need scarcely observe, that Mr. Hunter 
and Mr. Abernethy were men of deep re- 
flection. They were engaged in a profes- 
sion, which, had they not been sufficiently 
stinlulated by other, and perhaps higher, 
motives, of itself, would have occupied 
them in the daily study and application of 
the laws of life : hence it was only what 
might have been expected, that they should 
direct some portion of their considerations 
to its nature, Mr. Abernethy held the 
same opinion on this subject, as he believed 
to have been entertained by Mr. Hunter, 
and he advocated its probability. 

To state this briefly : it was, that life 
did not arise out of organization, or any me- 
chanical arrangement of parts ; but that it 
was some very mobile and subtle substance, 
superadded to organization. The manner 
in which Mr. Abernethy introduces his ad- 



249 



vocacy of such a view, is truly admirable : 
it is at once simple, modest, and philoso- 
phical : terms which were also distinguish- 
ingly characteristic of Mr. Hunter's mode 
of promulgating an opinion. " Since think- 
ing is inevitable," says Mr. Abernethy, " our 
" chief inquiry should be, how we ought to 
" think or theorize ; and, on this point, 
" Newton himself has condescended to 
" instruct us. Our theories, hypotheses, or 
" opinions — ^for to me all these words seem 
" to refer to one and the same act of the 
" mind — should be verifiable or probable, 
" and should rationally account for all the 
"known phenomena of the subjects they 
" pretend to explain : under which circum- 
" stances, it is allowable to maintain them 
" as good, until others more satisfactory be 
" discovered. No man, wdio thus theorizes, 
" need feel shame in this employment of 
" his intellectual powers ; no man need feel 
" arrogance, for it is acknowledged that his 
" theory is but a probable and rational con- 
" jecture. Besides, we never can be sure 
" that the series of facts belonging to any 
" subject is full or complete ; new ones 



250 



" may be discovered, that would overturn 
" our best-established theories. Upon the 
" foregoinng terms alone, do I wish to up- 
" hold Mr. Hunter's theory of life," &c. 

I will not injure the foregoing quota- 
tion by further remarks on it. Amongst 
many other reasons which induced Mr. 
Abernethy to think in the manner to which 
I have alluded, you will find the following: 
— He saw that life was connected with an 
infinite variety of organization ; and hence 
he coukl not believe that it was the conse- 
quence of any one of them. If, therefore, 
life were not the consequence or result 
of the molecular arrangement or organiza- 
tion of matter with which it was connected, 
the conclusion that it was superadded, 
seemed inevitable. As its qualities were 
altogether inscrutable, by any power with 
which we are gifted ; impalpable, invisible ; 
but manifesting, at the same time, uncom- 
mon celerity in its actions : so he thought 
that it was something very mobile and very 
subtle. Now, if there was anything un- 
reasonable in this view, or anything unpro- 
fitable in its promulgation, — and it is diffi- 



251 



cult to perceive eitlier one or the other ; — 
still it constitutes " the very head and front 
of his offending." But it has been asserted, 
and by many the impression is still retained, 
that Mr. Abernethy considered life to de- 
pend on electricity. He never maintained 
any such doctrine; and it is quite extra- 
ordinary that he should have been so mis- 
represented. 

It happened that once, during Mr. Aber- 
nethy's life, I had a dispute on this very 
subject, with a gentleman whose intimacy 
with Mr. Abernethy should have taught 
him better : and the reference we made to 
Mr. Abernethy himself, drew from him a 
confirmation of that view of his meaning 
which I had entertained ; and which I con- 
tend is so clearly laid down in his Works, 
as to forbid any other conclusion*'. In the 
exercise of that talent which he possessed, 

* " It is not meant to be affirmed that electricity is lilc. 
" I only mean to argue in favour of Mr. Hunter's theory, 
" by shewing that a subtile substance of a quickly and pow- 
" erfully mobile nature seems to pervade everything, and is 
" the life of the world ; and that therefore it is probabk>, 
" that a similar substance pervades organized bodies, and is 



252 



of illustrating difficult subjects, he was ac- 
customed to illustrate his views of life by 
shewing its analogy with electricity ; but 
he never meant to identify the two prin- 
ciples ; nor to apply the facts observed in 
the actions of electricity in any other way, 
than to explain his ideas of that which w^as 
altogether inscrutable, -by that which was, 
to a certain extent, known ; to explain, by 
reference to the superaddition of electricity 
to a wire, for example, his ideas of the rela- 
tion of life, and the mode of its connexion, 
with matter. 

It is not expedient here to speculate 
on the correctness or incorrectness of those 
views of life which were advocated by Mr. 
Abernethy ; still less would I say that they 
will never be found to have been prophetic 
of the truth : for when we consider that 
electricity is now allowed to pervade all 
nature, — that its identity with galvanism 
and magnetism may be regarded as proved, 

" the life of those bodies. I am coucerned, but obliged to 
" detain you by this recapitulation, because my meaning has 
"been misunderstood or misrepresented." 

Abernethy s Introductory Lectures. 



253 



— when it is found, as Sir Humphrey Davy 
shewed long since, that electrical agency 
not only controls the laws of cheniical 
affinity, but that chemical actions are in 
truth electrical, — when we recollect that, 
not content with admitting that electricity 
inhabits all bodies, we are bemnnino; to 
think of its definite proportions, — when 
various phenomena powerfully suggest the 
idea, that light, heat, and electricity, if they 
be not identical, are some mysterious mo- 
difications of each other, — w^hen a subtle 
agent, like polarized light, seems to have 
proved a difference in the molecular arrange- 
ment, of substances, which chemistry has 
hitherto believed to be identical, — and 
when, lastly, we see an electric battery 
fairly the product of life, as in the gymnotus 
electricus, and torpedo, — may we not ex- 
pect, without being very unreasonable, that, 
at no distant period, we shall regard the 
phenomena of electricity as something 
more than a happy illustration of the actions 
of life; and be obliged to acknowledge, the 
probability at least, that electricity, so 
largely employed as an instrument of Oni- 



254 



nipotence, either does exert some import- 
ant injluenee on the Icms of vital action, 
or that animal life is the only assemblage 
of pheno?nena, in the regulation of which 
it exerts no power. 

To proceed, however, to the consider- 
ation of opinions more obviously connected 
with the practice of surgery, and to mention 
one other instance of coincidence in the 
views of Hunter and Abernethy : — I would 
observe, that Mr. Hunter, in lectures which 
are reported to have been laboriously de- 
livered to an ungrateful, because, too often, 
an inattentive audience, was elaborate in 
describing those important phenomena, 
which constitute the various sympathies of 
the body ; his object being to shew, as Mr. 
Abernethy used to express it, that the whole 
body sympathized with all its parts. 

Mr. Abernethy laboured to demonstrate, 
if not to an inattentive audience, certainly 
amidst the suppressed sneers* of many of 
his hearers, that diseases of parts of the 

* Mr. Abernethy used to observe, that some people said 
he was mad : perhaps now, thej would be satisfied in consi- 
dering him to have been originaL 



255 



body had constitutional origins or con- 
nexions. Whether the two opinions were 
of independent formation, or whether the 
latter were an emanation of the former, 
here we see the universal sympathy of John 
Hunter linked with the " Constitutional 
Origin of Local Diseases" of John Aber- 
nethy. 

The influence exerted by the chylo- 
■ poietic viscera in various diseases, and on 
particular states of the nervous system, liad 
been recognized from the earliest times ; 
nor would it be difficult to adduce evidence 
of this recognition from the writings of the 
Greek and Arabian physicians, or those of 
enlightened men at all periods. In some in- 
stances, this is so marked, that (as is the case 
with regard to many important discoveries — 
the circulation of the blood, for instance) we 
are surprised that men who evinced such 
power of observation should not have pro- 
ceeded a little further, and have arrived at 
the important inductions so obviously aris- 
ing out of the facts which they had observed. 
Mr. Abernethy, however, appears to have 
been the first person who fully ap])reciated 



256 



such facts ; and, by shewing how they were 
legitimately deducible from physio-patholo- 
gical principles, at once lui veiled^ as it were, 
the universality of their apphcation. Truth 
has been said to lie near the surface. Mr. 
Abernethy's views appear to rest on a few 
simple propositions, which, separately con- 
sidered, are so obvious as to appear little 
more than truisms ; but which, considered 
in connexion, constitute the basis of scien- 
tific surgery. 

Thus, great local irritation will produce 
great constitutional disturbance ; a less de- 
gree of local irritation will produce a less 
degree of constitutional disturbance ; and 
these, reciprocally. The state of the ner- 
vous system, and of the chylopoietic viscera, 
will influence and maintain constitutional 
disturbance; and, further, in the mainte- 
nance of a disordered state of nervous sys- 
tem, there is nothing which more powerfully 
contributes thereto, than disturbance of the 
digestive organs, nor any thing which more 
effectually relieves it than producing a tran- 
quil condition of them. I shall shew you, 
hereafter, how the whole practice arises out 



257 



of these simple propositions. It may be 
well, however, even here, to consider Mr. 
Abernethy's opinions a httle more in detail ; 
for although to some it may soimd strangely, 
yet it is nevertheless true, that he continues 
to be much misunderstood and misrepre- 
sented. Facts which were the gradual 
accumulation of vigilant observation, as well 
as the principles which were carefully and 
legitimately deduced from them, are fre- 
quently considered as having been wrested 
to conclusions to aid a favourite theory, or, 
as the creations of an imagination fertile in 
resources for the support of pre-conceived 
opinions ; whilst views of disease eminently 
remarkable, for a comprehensive perception 
of all those agents which exert an injurious 
influence on the animal oeconomy, have 
been represented as referring all disorders, 
if not to a single organ, at least to the chy- 
lopoietic viscera. 

In order to examine whether these alle- 
gations be founded in truth, let us take a 
cursor}^ view of those agents, which are 
acknowledged by all to be chiefly influential 
in the production of diseases, and also, of 
s 



258 



the organs on which they for the most part 
primarily operate ; and then, examine hov/ 
far they were recognized by Mr. Abernethy. 
1st. There is the influence of the kind of 
air we breathe : 2dly. Our food (both fluid 
and solid) : 3dly. Changes of temperature : 
4thly. Impressions primarily made, either 
of a physical or moral kind, on the nervous 
system : and, lastly. Substances, sometimes 
of a tangible nature, sometimes impalpably 
blended with the atmosphere, at others, in- 
extricably involved in the general pheno- 
mena of specific diseases, and which are 
included in the catalogue of poisons, using 
that term in the full extent of its technical 
application. As structures on which these 
influences primarily act, consideration sug- 
gests, — 1st. The skin : 2dly. the viscera of 
the chest : 3dly. the chylopoietic viscera : 
and, again, the nervous system. If this 
sketch do not present you with a compre- 
hensive view of the sources of diseased 
action (for I say nothing of accidents in this 
place), you will find difficulty in suggesting 
any malady which the profession would 
hesitate to admit might be properly classed 



259 



under one or other of the divisions it im- 
phes. The question is, then, were sucli 
divisions recognized by Mr. Abernethy P 
and the answer is, undoubtedly they were — 
and in a very marked manner. How largely 
did he expatiate on the influence of the 
nervous system, — how much on that of the 
air we breathe, — how much on the import- 
ance, both generally and locally, of regu- 
lation of temperature, — how original and 
interesting was he on the subject of poisons, 
— and how clear and convincing on the 
influence of diet, and the condition of the 
digestive organs. What, then, becomes of 
the charoe of seeino; all diseases through one 
medium ? How is such a charge recon- 
cileable for one moment, with an enlight- 
ened and enlarged physio-pathology (to 
use one of Mr. Abernethy's own words), 
which professed to place its very founda- 
tion on the sympathy of the whole body 
with all its parts. No, Gentlemen, I can 
assure you, from ample opportunities of 
observation, — from many years' attendance 
on his lectures, — from private conversations 
on all subjects on which I had any doubt, 
s 2 



260 



as well as a careful perusal of his written 
compositions, — Mr. Abernethy entertained 
no such narrow views, as those which are 
sometimes imputed to him ; but he did 
believe, and strongly contended for this 
point — that, from whatever causes they 
might have originated, diseases were liable 
to considerable modifications, from the ex- 
isting conditions of the chylopoietic viscera. 
That, in fact, disorders of these important 
organs would aggravate the malady, what- 
ever might be its nature ; and that disorders 
acting primarily on other parts of the body, 
or on the nervous system, would produce 
disturbance in the functions of the digestive 
organs, — which organs, reacting on the 
causes which so disturbed them, would 
thus increase the general disorder. If, at 
this day, you would have proof of these 
propositions, — its production is easy. The 
difficulty is, to select that out of the vast 
multitude, with which the least reflection 
supplies us, best adapted to impress the 
conviction it conveys. Shall we look for 
the extended influence of the chylopoietic 
viscera, in the helplessness of the cradle. 



•261 



in the tott(3riiig commencement of early 
life, in the progress of adolescence, in the 
full vigour of manhood, in the varying 
conflict of life with declining years, or 
when its thread is nearly spun, and man is 
approaching the mysterious precincts of 
the tomb ? It is unimportant, Gentlemen, 
what period of life we select for our obser- 
vation, since we shall not fail to discover 
unequivocal proofs of this influence in all. 
We frequently recognize its agency in the 
variable severity of teething, and the cuta- 
neous diseases which accompany this pro- 
cess, in the modifications of the exanthe- 
mata, as also in other less febrile eruptions. 
If we select a disease, whose strong specific 
characters would seem calculated, a priori^ 
to confer on it an exemption from influ- 
ences of a general nature, as small pox ; or 
one, the obtrusive character of whose local 
manifestations, seems to have occasioned a 
blindness, or inattention to those links 
which connect it to a disordered system, 
like porrigo, — we, nevertheless, find disor- 
ders of the dio'estive orfjans, conferrino; a 
dangerous malignity on the one ; and, mea- 



262 



SLires directed to restore and maintain a 
tranquil condition of these organs, the only 
certain source of rehef in the other. In 
the middle periods of life, are not the va- 
rious inflammatory diseases, as well as those 
dependent on specific poisons, modified in 
their effects by the condition of the diges- 
tive organs ? Of the former, the history 
of phlegmonous erysipelas alone aflfords 
abundant illustration ; and of the latter, I 
would select, as examples, with equal con- 
fidence, either syphilis, the Protean class 
which simulates it, or the disorders so often 
occasioned by the abused administration of 
mercury. Do we not see the proofs of the 
modifying power to which I am referring, 
in the varying consequences of the same 
degree of local injury, in the manner, dura- 
tion, and facility of repair ? In the more 
advancing periods of middle age, I need 
scarcely observe how often those insidious 
beginnings of that, which in old age is to 
become disease, are mixed up with a teaz- 
ing condition of the digestive organs, in 
which medical science is frequently so 
baffled, as almost to welcome a tangible 



263 



disease as a substitute for an impalpable 
nervous disorder. In old age, when the 
efforts of science can but smooth the road, 
and ease the journey which they can scarce- 
ly retard, it must be familiar to most of you, 
of how much consequence is the due regu- 
lation of the quantity and quality of the 
food ; — how often the function of digestion 
requires those considerations, suggested by 
declining power : and even where the sto- 
mach seems still to retain a vigour, in but 
inconvenient keeping with an enfeebled 
frame, how frequently it happens that we 
dare not trust its exercise ; how^ important 
this limitation becomes, in guarding against 
those dangerous determinations, too com- 
monly incidental to a declining and partial 
circulation ; and in warding off or abridg- 
ing the insidious, but no less dangerous, 
influences of gout, rheumatism, and other 
well-known sources of structural disorgan- 
ization. How beneficial in relieving suf- 
ferings of the various diseases of the urinary 
organs, — or, once more to speak of a dis- 
ease apparently local, in mitigating the 
annoyances of the prurigo senilis. In 



•264 



short, the influence of which I have been 
speaking, prevails everywhere ; not only at 
the various stages, as it were, of Hfe, but at 
all intermediate portions of the journey. 

Whether we regard diseases, usually con- 
sidered, because apparently local, or those 
of evidently constitutional origin, — whether 
we direct our attention to those affections 
which are the results of more ordinary, 
or more cognizable causes, or contemplate 
those consequent on specific poisons, — 
whether we consider diseases of parts of 
the body, spontaneously occurring ; or those, 
the results of accidents or injuries, we alike 
find that the condition of the chylopoietic 
viscera, subjects all to important modifica- 
tions. We know, too, that what is consi- 
dered as perfect health, is not without its 
good and bad days, — its seasons of strong 
and weak nerve ; and although it is per- 
fectly true, that disorder of the digestive 
organs is neither at such times invariably 
the cause, — nor its correction, the cure : 
yet it must be admitted that, even where 
the injurious impressions have been al- 
together directed primarily to the nervous 



265 



system, that the condition of these flinc- 
tions is equally important in lending force 
to the cause, and facility to the cure. For 
present purposes of illustration, the facts to 
which I have adverted will be sufficient ; 
hereafter, I shall bring the evidence to bear 
on individual diseases, in order to enforce 
the principles which it inculcates, as well as 
to shew you, that however imj^ortant the in- 
fluences of which I have spoken^ you must 
not look exclusively to them in the treatment 
of diseases. I only here add, that when ana- 
tom)^ informs us of the vast bulk of the 
digestive organs, — of the extensive and 
highly organized surface of the alimentary 
canal, which, were it extended on a plane, 
would be found to be not less than seve- 
ral square feet. The enormous quantity of 
blood by which these parts are supplied, — 
the great bulk and complicated structure of 
those organs, part at least of whose office, 
we must believe, is to assist in the function 
of assimilation ; — when we reflect on the 
manner in which the chylopoietic viscera 
are connected with the cerebral, spinal, 
and ganglionic systems of nerves, — when 



266 



physiology unfolds to us, that the materials 
of which our bodies are composed are un- 
dergoing a constant mutation, for which the 
digestive organs constitute the only source 
of renewed supply, — that the blood which 
they elaborate for this purpose, with the 
additional influence of atmospheric air, fur- 
nishes every variety of structure, the brain 
not excepted, with the required support ; — 
when we observe, too, those important facts, 
which I have no time to consider at present, 
but which, as a whole, constitute the phe- 
nomena of sympathy ; and which, though 
they explain not the nature, yet demon- 
strate the existence, of a mysterious con- 
nexion of the digestive organs, with every 
important structure, as well as with each 
other ; and when every disease, but mode- 
rately studied, serves but to illustrate that 
which anatomy, physiology, and common 
observation alike combine to teach. When 
we consider these things, I say, instead of 
being sceptical or restricted in our convic- 
tion of the influence of the chylopoietic 
viscera, should we not rather wonder, that 
the proper and extended bearing of these 



267 



truths on tlie practice of surgery, sliould 
have been reserved for the eighteenth cen- 
tury, and John Abernethy. 

Now it may be said, that Mr. Abernethy's 
opinions are established, that their influence 
in the treatment of diseases is well under- 
stood and acknowledged, and that it is seen 
in the every-day practice of the profession. 
There is something of truth, but much more 
of errror, in the foregoing assertions. That 
the regulation of the functions of the di- 
gestive organs is not wholly neglected, even 
by the least informed, is admitted ; nor is 
the general principle of their influence in 
diseases denied. But how is this loose cre- 
dence in Mr. Abernethy's views, much less 
the perception of the enlarged pathology 
by which they are characterized, evinced ? 
I speak it not irreverently, when I say, that 
here, as in matters of still graver import, 
our faith must be judged of by our works. 
It is in vain that we profess a respect for 
the opinions of Mr. Aberneth}-, if we act 
in daily violation of the laws which it has 
been their object to establish. If, for ex- 
ample, in the treatment of diseases, our 



268 



endeavours to adjust the quantity and qua- 
lity of food to the digestive powers, consist 
in a few vague general directions, modifi- 
able by the equivocal interpretation of ca- 
price or inclination ; if our internal reme- 
dies, presented, first, to so important an 
organ as the stomach, be given at intervals, 
having no well-considered reference to the 
condition of that organ ; if, in the adminis- 
tration of remedies, we increase the diffi- 
culties inseparable from an enquiry into 
their effects, by unnecessary variety and 
complexity in their prescription ; if local 
remedies be administered without due con- 
sideration of the state of the part, and of 
the constitution, gifted with an universal 
sympathy ; and, lastly, if all these errors 
occur at one and the same time, so that we 
are equally at a loss to know to what we 
are to attribute success, or to what to as- 
cribe failure, what boots it that the perpe- 
trator of such practice profess a belief in 
the opinions of Abernethy ? For my part, 
I view such a practitioner (and, if you will 
only observe, you will find that I state no 
fictitious, nor even uncommon case) as more 



269 



opposed to the diffusion of the principles 
which I would advocate, than he who pro- 
ceeds on an avowed disbelief of them. The 
latter may now and then stumble on a fact, 
with which the disturbed functions of 
nature will sometimes awaken even the 
most obtuse and unobservant ; but the 
former is in a voluntar}^ darkness, in which 
the fact would altogether escape observa- 
tion, or only serve to confirm him in error, 
but inducing him to ascribe it to the un- 
soundness of the very principles, of whose 
truth it might be an emphatic example. I 
now proceed to offer a few remarks on the 
practice of Mr. Abernethy ; to shew how 
its great simplicity, and somewhat limited 
catalogue of ordinary therapeutic resources, 
are reconcileable with what I have termed 
an enlightened and enlarged pathology. 

Mr. Abernethy was a surgeon, and edu- 
cated at a period when medical surgery, 
which he himself contributed so largely to 
establish, was but little known. He was 
accustom.ed, for the most part, to remedial 
agents, whose effects he could watch with 
something like accuracy; and was not in 



270 



the habit of prescribing medicines in that 
variety which is now so common. Mr. 
Abernethy was a close reason er ; and no- 
thing is more difficult than to reason closely 
on the effects of remedies. That undefined 
peculiarity, which we call the idiosyncracy 
of individuals ; numberless varieties in the 
condition of the nervous system in general, 
as well as that of individual organs, many 
of which we have no means of discovering, 
and scarcely any of which we can be said 
really to understand ; the influence of life, 
in forming chemical combinations, on which 
we may not have calculated, as well as in 
modifying or preventing those which we 
intend should take place ; the varying qua- 
lities of drugs, rendered still greater by 
the unprincipled adulterations of commerce, 
and a number of other circumstances, ren- 
der the science of medicine so fraught with 
difficulty, that we can hardly imagine any 
thino; more laborious or uninviting. No 
sooner does the mind, wearied with unfruit- 
ful attempts at some useful practical induc- 
tion, grasp at what appears a legitimate 
conclusion, than some new or unexpected 



271 



anomaly presents itself, which renders 
doubtful, or perhaps falsifies, the law we 
had hoped to have established. If, there- 
fore, the branch of the profession practised 
by Mr. Abernethy, did not oblige him to 
investigate largely the effects of internal 
remedies, there seemed still less chance of 
his being induced to do it, from inclination. 
When, at length, Mr. Abernethy's great 
reputation led so large a number of persons 
to consult him on medical cases, he seems 
to have relied, and not unnaturally either, 
on the practice which he had so often seen 
successful ; the cases differing probably but 
little from those with which surgical prac- 
tice had previously furnished him, except 
in the absence of external manifestations of 
disorder. I think it is to be regretted, that 
Mr. Abernethy did not investigate the ef- 
fects of medical remedies more extensively ; 
for, judging by the application he has made 
of those he did employ, we are justified in 
concluding, that his enquiries would ha\-e 
added some useful results to our therapeu- 
tical knowledge. M\\ Abernethy, however, 
employed but few remedies, and those 



272 



chiefly of a kind, whose effects were, for 
the most part, well ascertained and admit- 
ted*. In this respect he seems, w^ith a cha- 
racteristic rapidity of perception, to nave 
begun where most of the profession finish ; 
and, in early life, to have commenced with 
that simple sort of Pharmacopoeia, which, 
even in such men as Sydenham, Baillie, and 
most other distinguished pathologists, ap- 
pears to have been the slowly accumulated 
product of experience and disappointment ; 
to have forestalled that state of things, 
which has been described as characteristic 
of the life of the physician, who com- 
mences by having several remedies for every 

* Amongst the various misconstructions of Mr. Abernetli}', 
it has been thought, that he disregarded local remedies ; 
whereas he was fullj acquainted with their just value. His 
treatment of susceptible surfaces, for example, — his mode of 
endeavouring to quiet local irritation, whilst he prosecuted 
his endeavours to tranquillize general disturbance, is another 
example of his attention to local matters, as it is of good 
surgery. In connexion with this, I may mention that no one 
could be more particular than he was, in keeping diseased 
joints motionless, by splints : a practice of great importance, 
and recently recommended by Sir Benjamin Brodie; but 
apparently without being aware of the fact I have just stated 
— as Mr. Abernethy is not mentioned. 



273 



disease, and concludes by having many dis- 
eases for which he has no remedy. Al- 
though Mr. Abernethy employed but few 
medicines himself, he was far from being 
opposed to a more extended use of the 
Pharmacopoeia, and always listened to a 
well-digested narrative of the effects of a 
particular remedy with respect and atten- 
tion. In giving you, however, a faint out- 
line of Mr. Abernethy's principles and 
practice, you will see, as we proceed, that 
I shall be far from recommending a servile 
imitation of him in points of detail. No 
one can, I trust, have a higher respect or 
veneration for his opinions ; but I would 
not blindly follow those of any man. The 
mode by which we best testify our respect 
for the opinions of an individual, is, by 
bringing our best energies to an unbiassed 
examination of them. If they be true, the 
more we examine, the more we shall ad- 
mire ; whilst, perhaps, in the practical a})- 
plication of them, careful consideration may, 
even to very subordinate capacities, suggest 
useful modifications, which may have es- 
caped the expansive generalizations of tlieir 

T 



274 



author. Again, if a principle be true, the 
multitude of phenomena to which it may 
apply, are scarcely ever known at the time 
that the principle is first promulgated. In 
almost every example which the sciences 
afford, there are always accumulating facts, 
which are constantly awarding to it a wider 
range of application. I believe you will 
find these remarks apply to Mr. Aberne- 
thy's opinions, whilst they demonstrate 
their increasing value. I shall not hesitate 
in mentioning to you, in their proper place, 
such modifications, or extended applica- 
tions of them, as have occurred to myself. 
Where I think that the genius of Mr. 
Abernethy may have generalized too has- 
tily, I shall not shrink from expressing my 
conviction. Although he seldom prescribed 
without seeing, or believing that he saw, 
the principle, or at least the organ, on which 
the remedy was to act, it will be right to 
tell you, that the state of medical science 
frequently denies us this gratifying condi- 
tion ; but that, notwithstanding, we must 
not hesitate in employing that which ex- 
perience may have proved useful. Speak- 



•275 



ing generally, when I may be considering 
the various ways in wliich medicines act on 
different individuals, and under different 
circumstances, I shall not scruple to recom- 
mend to you a more extended use of our 
Pharmacopoeia ; not, perhaps, than Mr. 
Abernethy would have sanctioned, but than 
he would himself have employed. In ex- 
amining his opinions freely, we shall, as I 
believe, make the best use of the splendid 
legacy which he has left us, in extending 
the practice of an improved surgery ; and 
in shewing the application of his principles 
under modified forms, to diseases in which 
they may have been hitherto deemed in- 
effectual ; and thus rest the perpetuity of 
his name, not on the monumental marble, 
nor even on a splendid museum, but on 
an increasing power in the prevention and 
cure of disorders, on a diminishing recourse 
to painful and dangerous operations, and 
on an extension of those colossal traces of 
his genius, already seen, in an improved 
medical surgery, throughout the civilized 
world. Referring generally to his o])inions, 
I would advise you to postpone the consi- 

'r -2 



276 



deration of his views of life, and take sub- 
jects better adapted to your present ob- 
jects ; to study well his views of physio- 
logy and pathology ; to inform yourselves 
thoroughly of the principles on which he 
would administer remedies, without limit- 
ing yourselves to his restricted Pharmaco- 
poeia ; to regard diet as a thing of vast im- 
portance in the treatment of diseases, but 
to recollect that it is only one point in the 
management of them, and that different 
cases may require very considerable modi- 
fications, both in the manner and matter 
of its administration ; to keep before you 
the bright example which Mr. Abernethy 
afforded of the honourable practice of an 
arduous profession, without imitating the 
uncourteous manner by which it might 
have been occasionally sullied ; to emulate, 
each in his ability, that enlarged benevo- 
lence which disbursed such vast sums, an- 
nually, to distressed brethren, without ex- 
hibitincr the rou^h exterior, beneath which 
such a heart was concealed ; and, let me 
add the hope, that, in imitating such a god- 
like feature in his character, neither the ab- 



•277 



sence of moral couragCj nor the presciico oi" 
flattery, may prevent you from shedding 
the lustre of a discriminating justice, over 
your benificent dispensations. 

The lectures. Gentlemen, which I pro- 
pose to give, then, will, in the liberal sense 
of the term, be based on the principles 
which were taught by Mr. Abernethy ; and 
the practice they recommend will, I trust, 
be exemplified and enforced by Clini- 
cal illustrations. I need scarcely observe, 
that this Institution affords a large field for 
observation : here you may judge for your- 
selves whether those views promulgated 
by Mr, Abernethy were merely ingenious 
theories, or whether they were faithful 
transcripts from the book of Nature. If 
they stand not the test of practical applica- 
tion, you will do right to reject them. If, 
on the contrary, this test should demon- 
strate their truth and value, I trust that you 
will spare no pains in rendering yourselves 
thoroughly acquainted with their applica- 
tion, not only in those diseases which may 
be comprised in an imperfect course of 
clinical instruction, but in the general 



278 



practice of surgery as taught in systematic 
lectures. 

In systematic lectures, the student is 
taught what he is to look for — how he 
should endeavour to elicit the information 
which he seeks. The usual history, causes, 
symptoms, diagnosis, prognosis, and treat- 
ment of disease, are methodically described, 
with such an arrangement of rule and ex- 
ception, as the infinite varieties of morbid 
action render practicable, consistently with 
clearness : and most useful, certainly, such 
lectures are. The student is, however, here 
dependant on the teacher ; the correctness 
of whose views, he is, in some measure, 
compelled to admit, until he has oppor- 
tunities of forming his own. In clinical 
instruction, the book of Nature is alike un- 
folded to the student and his preceptor. 
No ingenuity or preconceived opinion, can 
materially colour or distort the facts, alike 
accessible to both. The reasoning of the 
teacher, as well as the practice he deduces 
from it, are put to the test of experiment ; 
and the various forms of disease, as they 
occur in nature, — so infinite, as to defy 



279 



systematic classification, — are seen under 
circumstances best calculated to impress 
them on the recollection. Whilst, there- 
fore, systematic lectures are highly useful, 
they seem chiefly so, as preparing the stu- 
dent for clinical instruction : without this, 
whether he seek it in the practice of others, 
or wait until he slowly accumulates it amidst 
the absorbing anxieties of his own, he can 
scarcely pursue his profession wdth comfort 
or advantage. The lectures, then, will be 
chiefly clinical ; and as the subjects of them 
will therefore necessarily be regulated by 
the cases which have recently been, or 
which are, at the time, under treatment, 
they will be often little more than extem- 
poraneous. I shall endeavour, however, 
not to lose sight of the practical points, 
whether they be all demonstrable or not, 
in the cases in question. The importance 
of the surgical practice, offered by large 
dispensaries, has not been duly appreciated, 
because, perhaps, till recently, not known 
by our public bodies : for whilst too much 
can hardly be said, of the opportunities of 
information presented by our noble hos- 



280 



pitals ; still they shew nothing, more or less 
of which, is not to be seen in a dispensary : 
whilst, on some points, dispensaries have 
even the superiority. 

Hospitals have an advantage over dis- 
pensaries, in the greater accommodations 
they afford to patients labouring under ac- 
cidents, or requiring operations ; in the 
consequently greater number of such cases, 
and in the control which may be exercised 
over the habits of the patients, so material 
in the accurate investigation of the effects 
of remedies, and in enforcing the prescribed 
treatment ; advantages alike important to 
the interests of science, and, in cases of 
contemplated insubordination, to those of 
the patients also. But again, the large 
number of pupils, consequent on the mono- 
poly which hospitals enjoy, constitutes, prac- 
tically, a material subtraction from some of 
these advantages. On the contrary side, 
it is to be observed, that many diseases are 
seen in dispensaries better than in hospitals. 
The following is a catalogue of diseases, 
some of which are scarcely seen at all in 
hospitals, and all of which are seen as well. 



281 



and for tlie most part better, in dispensaries. 
Infantile diseases generally — such as disor- 
ders incidental to teething, strophulus, por- 
rigo, small-pox, measles, scarlatina, hooping 
cough ; constituting together so important 
a feature in the occupation of the general 
practitioner. To these may be subjoined, 
cutaneous diseases wnerallv, ulcerations of 
the lower extremities, and diseases of the 
aged ; incipient affections of the joints and 
of the urinary organs, diseases of the eye, 
the various disorders connected with utero- 
gestation and lactation, with fever of very 
variable type and severity. As the Legis- 
lature is now informed on these points, let 
us hope that dispensaries will, ere long, be 
recognized as competent fields for instruc- 
tion. This would increase their useful- 
ness, and add to that of the hospitals, by 
encouraging competition, which is, as I 
once heard justly observed, " the surest 
source of excellence." You vv'ill not, how- 
ever. Gentlemen, in the practice of a 
dispensary, discover those powerful im- 
pulses which operate elsewhere. Dispen- 
sary practice, abstractedly considered, pre- 



282 



sents few of those rewards, either of fame 
or fortune, which are calculated to excite 
the zeal and animate the industry of the 
hospital surgeon — none of those comforts, 
which at least diminish labour, if they do 
not relieve responsibility. Your operations, 
instead of being performed in roomy, light, 
airy, and otherwise well-adapted theatres, 
with " all appliances and means to boot," 
must be frequently performed in the 
crowded, dark, ill-ventilated abode of filth, 
poverty, and wretchedness ; and (your own 
instruments excepted) with such other con- 
veniences as an extemporaneous ingenuity 
can often but imperfectly supply. But 
even here again there are some advantages. 
Dispensary practice will shew you many a 
page in the book of nature, unfolded no- 
where besides. The localities of disease, 
and the habits of patients, are nowhere so 
well seen as in their homes ; and the same 
may be said of the influence of physical 
suffering in the development of moral cha- 
racter. The view presented to you of the 
misery of disease, with poverty and its af- 
flicting complication S5 will awaken your 



sympathies with the wretched, and teach 
you thankfulness for the health which you 
may enjoy. Naturally, thus exalting your 
ideas of the usefulness of your profession, 
it will, I should hope, inspire you with 
additional zeal in its study. Dispensary 
practice may teach you also other lessons, 
not without their value. The various dif- 
ficulties that may beset your path, or dis- 
gust your sensibility, nay, even the ingra- 
titude with which your attentions may be 
occasionally received, may, by reflection, 
be turned to advantage. 

The first, will inform you betimes, that 
the profession which you have embraced is 
no play- work, and excite corresponding 
energy, whilst youth and health afford you 
a liberal supply ; whilst an early drilling in 
the difficulties of public practice, will render 
those of private professional life compara- 
tively trifling, and thus leave you less en- 
cumbered to support its somewhat increased 
anxiety. The ingratitude will teach you, 
that even in the administration of beneflts, 
which the best part of your lives have been 
spent in obtaining the power of conferring, 



284 



and which, when accomplished, constitute 
the best gift that man can confer on his 
brother — that even here you must be phi- 
losophers, superior to common motives, 
and look to the mens sibi conscia recti as 
your chief reward. 



285 



In the subjoined iittompt at a tabular arrangemcMit oftlie 
more common order in which important parts manifest their 
sympathies, it should be understood that I address it to stu- 
dents, and those of my younger brethren who may not ha-s^e 
had their attention as yet directed to the subject ; and I beg 
them to understand that it is only to be regarded as an at- 
tempt at an approximation to the truth. The nature of the 
subject does not admit of more than this, unless it were in a 
work expressly devoted to the consideration of Sympathy, 
and the enumeration of the whole of its phenomena. The 
table, therefore, is exceedingly imperfect ; and I cannot too 
strongly impress the necessity of placing only a very mea- 
sured reliance on it. Thus checked by the observation of 
individual cases, it may invite an examination of the sym- 
pathies without misleading the examinator, and without dis- 
gusting him in finding such numerous exceptions to what it 
appears to establish as a general rule. The organ supposed 
to be primarily affected, or the more prominent object of in- 
vestigation, is placed first, and so distinguished. The organs 
sympathetically affected, are ranged below it, in the order 
or prominence in which they are supposed to evince their 
sympathetic excitability. T may observe further, that, with 
relation to the organ supposed to be primarily affected, the 
more common disturbances have been kept in view. Thus, 
the more common disturbance of the brain, generally sup- 
poses some irregularity in its circulation, as congestion ; in 
which more or less evidence is generally shewn by the exter- 
nal senses, especially sight or hearing. I do not mean defect 
in their sensual perceptions, so much as noise in the head, 
of some kind or another, as regards the ear ; or some tempo- 
rary morbid sensations in the eye, as irritability. If the 
brain be seriously affected, the organs of voluntary motion 
would come first in the list ; but this is comparatively the 
rare case ; whilst the most common headache scared v oc- 



286 



curs without unusual sensibility to light and sound. Similar 
difficulties occur in all the other sections of the table. In 
fact, the difficultj of arriving at the approximation I would 
seek (w*hen the endless varieties are considered, which are 
produced by various forms of disease, as well as different 
degrees of diseased action, essentiiilly the same in their na- 
ture, together with those differences which the idiosyncracieS 
of individuals daily present to our observation), is such as to 
render it, to me, very doubthil whether the table will be of 
any use at all. A judicious medical friend of mine, who was 
kind enough to consider this part of the subject, participated 
very fully with me in these doubts ; but we also agreed in 
one thing, which at length decided the question in favour of 
printing the table ; viz. that the very difference of opinion to 
which it must give rise, would probably provoke investiga- 
tion ; and as this is the object which, more than all others, 
I would desire ; considering the fact, of whether any views of 
mine be adopted or not, as immeasurably of little conse- 
quence, when compared with the importance of exciting 
more attention to an important subject, I have somewhat 
reluctantly added the table in question. The stars ( * ) are 
placed where the situation given to the organ has appeared 
more than usually doubtful ; and as enquiring whether it 
would have been better placed, where the superior star is 
touched by the bracket, ^ . 

NERVOUS SYSTEM. 
BRAIN"; organ supposed to be primarily or prominently 

affected. 
External Senses, one or more. 
Circulating System. 
Stomach*. 
Bowels. 
Liver. 

Skin and Kidney*. 



287 



NERVOUS SYSTEM generally : us pninurily nft^^ctiMl ; 

usually characterized by general in- 
creased susceptibility to impression. 

Circulating Organs. 

Secerning System, referring, in this place, more especially to 
the mucous membranes and skin ; and 
in the female, to the milk or catamenia. 

Uterus. 

Kidney. 

Stomach. 

Liver. 

Bowels. 



RESPIRx^TORY AND CIRCULATING 
ORGANS. 

HEART AND ARTERIES. 

Lungs and subsidiary respiratory organs. 

Skin. 

Kidney. 

Head. 

Chylopoietic Viscera. 
Serous Membranes. 



RESPIRATORY AND CIRCULATING 
ORGANS. 

LUNGS. 

Heart. 

Skin. 

Alimentary Canal. 

Kidney. 

Liver. 

Head. 

Uterus. 



288 



DIGESTIVE ORGANS. 

STOMACH 
Head*. A 
Bowels, r 
Liver. 
Skin*. 3 

Heart and Secerning System. 

External Senses. 

Uterus. 

Testicle, rarely. 



BOWELS ; as primarily affected. 
Head. 

Skin and Kidney, more or less latent, so as often not to 
suggest enquiry ; but on tins being made, 
almost always found sympathizing in 
every variety of disorder of tlie bowels. 

Stomach. 

Liver. 

Heart. 

Lungs ; but much earlier where there exists any predis- 
position to disorder. 



LIVER ; as primarily affected. 

Bowels. 

Head. 

Stomach. 

Heart and Lungs. 

Skin. 

Kidney. 

Uterus. 



289 



SKIN. 

SKIN. — Nothing more nncertaiu than the order in which it 
will excite sympathetic actions ; it will 
greatly depend on the state of" particular 
organs at the time that the impression on 
the skill is received. 

Kidney. 

Mucous Membranes — as of the nose, eyes, mouth, respira- 
tory, digestive, and urinary organs, and, 
perhaps, in the order mentioned. 

Vascular and Secerning System. 

Liver. 

Brain. 



URINARY ORGANS. 

KIDNEY. 

Skin. 

Stomach. 

Bladder and Urethra. 

Lungs. 

Heart. 

Bowels. 

Head. 



BLADDER 
Skill. 
Kidney. 
Urethra. 

Alimentar)' Canal. 
Testis, occasionally. 
Head. 



U 



290 



URETHRA. 
Bladder. 
Skin. 
Kidney. 

Stomach; sometimes reqiiiriug investigation, but generally 
obvaons enough. 

Fibrous Tissues. 
Rectum and Bowels. 

Testis. The testicle may appear low in the list, but its ready 
sympathy is chiefly seen in a few affec- 
tions only, whilst that of the other or- 
gans is, for the most part, constant. 

Head. 



GENERATIVE ORGANS. 

UTERUS. 
Stomach. 
Vascular System. 
Head.* * 
Bowels. * } 
Rectum.* 3 
Bladder and Kidney. 
Skin. 
Lungs.* * 

OVARY ; very uncertain, probably not very different from 
the uterus. The sympathy between these 
two organs are very irregular, sometimes 
being very excitable in disease, sometimes 
very little so. On the whole, the ovary 
seems to have a more ready sympathy 
with the uterus in disease, than the uterus 
with it. 



•291 



TESTICJ.E. 

Stomach. 

Skill. 

Heart and Arteries. 

The student will recollect that parts will general!} be 
affected so sinmltaneously, that order may not be distiuguish- 
able ; but yet some one will generally manifest a more pro- 
minent sympathy than others. In every affection of e\ ery 
organ, ihe vascular or nervous systems will syiupaihize 
more or less. This is therefore a question of degree rather 
than of Older of occurrence. 



POSTSCRIPT. 



In the concluding paragraphs I may 
have appeared to advocate the admission of 
dispensaries as competent surgical schools, 
as an addition to a system, of which I 
otherwise approve ; I only mean to say, that 
so long as the student is directed where to go 
for his information, it is wrong to exclude 
dispensaries. I contend that they aiford 
ample fields for the acquirement of profes- 
sional knowledge ; and I have had as good an 
opportunity of judging of both hospital and 
dispensary practice as is often combined in 
one individual. Recognized as competent 
schools, dispensaries would afford men some 
means of bringing whatever talent they 
might have to some account; who, when 
they do their duties conscientiously, labour 
much harder (and frequently without any 
remuneration but the information they ac- 
quire) than any men in the profession. On 
the other hand, I should be sorry to be 



294 



understood, for purposes in which I may 
appear interested, to advocate a system 
which I cannot conscientiously consider 
either just or useful. 

Abstract justice seems to me to require 
that all men should be allowed to obtain 
their information, when, how, and where 
they please. They should neither be con- 
fined to one institution nor another — the 
best check to incompetency being a full, 
fair, and efficient examination. As regards 
the efficacy of this test, I never heard in my 
life one single good argument impugning 
the security it offers, whilst it would be 
very easy to shew that the system of certi- 
ficates is most inefficient. 



FINIS. 



rUlN l KD UY J. MALl.KTT, WAKDOVH STKI KT, SOIIO^ I ONPON. 



